Provider Demographics
NPI:1003086109
Name:HEATH, GORDON ADAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:ADAIR
Last Name:HEATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 OCEAN ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2855
Mailing Address - Country:US
Mailing Address - Phone:207-221-3459
Mailing Address - Fax:
Practice Address - Street 1:96 OCEAN ST
Practice Address - Street 2:UNIT 4
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2855
Practice Address - Country:US
Practice Address - Phone:207-221-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0063962084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME006396OtherMAINE BOARD OF MEDICINE
FLME 99738OtherFLORIDA BOARD OF MEDICINE