Individual
PATRICK HEANEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA/C
Contact information
Practice address
186 MEDICAL VILLAGE DR, NEWPORT, VT 05855-8537
(802) 334-3520
(802) 334-3512
Mailing address
61 HOME ST, BERLIN, NH 03570
(603) 752-9252
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
055-0030775
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000297
—
VT
01
—
AP102301
MEDICARE
VT
Enumeration date
09/06/2006
Last updated
07/08/2021
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