Provider Demographics
NPI:1871585083
Name:HEINRICH, MARCELA ISABEL (MD)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:ISABEL
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-774-0707
Practice Address - Street 1:WESTGATE PEDIATRICS
Practice Address - Street 2:3746 VEST MILL ROAD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-774-0707
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98 00564208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891220FMedicaid
NC2266578AMedicare PIN