Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 37567 | MA |
N | 111NI0900X | Internist | 37567 | MA |
Y | 207RG0100X | Gastroenterologist | 37567 | MA |
NPI | 1023101896 |
---|---|
Provider Name | Frederick W Heiss |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 24/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110063842A | (05) | MA |
6167497 | (05) | MA |
A66756 | (02) | MA |