Active NPI
Mali Hetmaniuk, MD
- Pediatric Anesthesiology Physician
- Philadelphia, PA
National Provider Identifier
1851549604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Anesthesiology Physician
- License
- MT230480
- Practice address
- 3401 Civic Center Blvd
Division of Pediatric Cardiac Anesthesiology
Philadelphia, PA 19104 - Phone
- (800) 879-2467
- NPI assigned
- Sep 5, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD60372031 | WA | |
| Pediatric Anesthesiology Physician | 207LP3000X | DR.0064924 | CO | |
| Pediatric Anesthesiology Physician | 207LP3000X | MT230480 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Division of Pediatric Cardiac Anesthesiology
Philadelphia, PA 19104
Mailing address
3401 Civic Center Blvd
Division of Pediatric Cardiac Anesthesiology
Philadelphia, PA 19104
Other practice location 1
4090 Briargate Pkwy
Colorado Springs, CO 80920-7815
Phone (720) 777-1234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851549604 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DR.0064924 | CO | MD | Pediatric Anesthesiology Physician |
| MT230480 | PA | MD | Pediatric Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717113600000",
"number": "1851549604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"address_2": "DIVISION OF PEDIATRIC CARDIAC ANESTHESIOLOGY",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"address_2": "DIVISION OF PEDIATRIC CARDIAC ANESTHESIOLOGY",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "800-879-2467"
}
],
"practiceLocations": [
{
"address_1": "4090 Briargate Pkwy",
"address_purpose": "LOCATION",
"city": "Colorado Springs",
"state": "CO",
"postal_code": "809207815",
"country_code": "US",
"telephone_number": "720-777-1234",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HETMANIUK",
"first_name": "MALI",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-05",
"last_updated": "2024-05-31",
"certification_date": "2024-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "WA",
"license": "MD60372031",
"primary": false
},
{
"code": "207LP3000X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pediatric Anesthesiology",
"state": "CO",
"license": "DR.0064924",
"primary": false
},
{
"code": "207LP3000X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pediatric Anesthesiology",
"state": "PA",
"license": "MT230480",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1851549604",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.