Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 37852 | MA |
NPI | 1033209879 |
---|---|
Provider Name | Dr. Bernhard Heersink |
First Address | Newburyport, MA 01950 |
Second Address | Newburyport, MA 01950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 12/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D23039BS | BLUE CROSS BLUE SHIELD (01) | MA |
D88225 | (02) |