1558380600 NPI number — DR. HEIDI HABICHT PETERSON M.D.

Table of content: DR. HEIDI HABICHT PETERSON M.D. (NPI 1558380600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558380600 NPI number — DR. HEIDI HABICHT PETERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSON
Provider First Name:
HEIDI
Provider Middle Name:
HABICHT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWNLIE
Provider Other First Name:
HEIDI
Provider Other Middle Name:
HABICHT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558380600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 WASHINGTON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-761-5650
Provider Business Mailing Address Fax Number:
508-761-9870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-761-5650
Provider Business Practice Location Address Fax Number:
508-761-9870
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  159941 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MD11077 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0020858 . This is a "NEIGHBORHOOD HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 410071 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 3200302 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 711511 . This is a "HARVARD HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J25000 . This is a "MASS BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 159941 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: HB53533 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26483 . This is a "RHODE ISLAND BLUE CROSS/" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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