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MARK ROBERT HEITZMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
130 FISHER RD, MOB-A SUITE 2-1, BERLIN, VT 05602-9516
(802) 225-5660
(802) 229-2533
Mailing address
PO BOX 547, CENTRAL VERMONT MEDICAL CENTER-FINANCE DEPT, BARRE, VT 05641-0547
(802) 225-5660
(802) 229-9533

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
042.0006618
VT
207RI0011X
Interventional Cardiology Physician
420006618
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0005341
VT
01
060014973
RAIL ROAD MEDICARE
VT
01
P01125405
RAILROAD MEDICARE LINKED TO CVMC MGP
VT
Enumeration date
07/19/2006
Last updated
12/04/2014
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