Provider Demographics
NPI:1053550715
Name:HERITAGE MEDICAL GROUP, LLP
Entity type:Organization
Organization Name:HERITAGE MEDICAL GROUP, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CINCOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-761-0208
Mailing Address - Street 1:3 WALNUT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1168
Mailing Address - Country:US
Mailing Address - Phone:717-761-0208
Mailing Address - Fax:717-761-2023
Practice Address - Street 1:110 LOWTHER ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-2012
Practice Address - Country:US
Practice Address - Phone:717-774-2202
Practice Address - Fax:717-774-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007580840015Medicaid
PA014702Medicare UPIN