Individual
DR. ROBERT O HEUCKEROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA - GASTROENTEROLOGY, PHILADELPHIA, PA 19104-4319
(215) 590-3247
(215) 590-3606
Mailing address
100 E PENN SQ, 9TH FL, PHILADELPHIA, PA 19107-3323
(267) 425-9234
(267) 425-9299
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
104739
MO
2080P0206X
Pediatric Gastroenterology Physician
Primary
MD449684
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103810165
—
MO
05
—
126902
—
MS
05
—
430653611
—
LA
Enumeration date
07/17/2006
Last updated
10/21/2014
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