Provider Demographics
NPI:1033108568
Name:HEVERN, GERARD J (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:J
Last Name:HEVERN
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:PO BOX 9001
Mailing Address - Street 2:
Mailing Address - City:SUNCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03275-9001
Mailing Address - Country:US
Mailing Address - Phone:603-485-7861
Mailing Address - Fax:603-485-2437
Practice Address - Street 1:50 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:ALLENSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03275-2366
Practice Address - Country:US
Practice Address - Phone:603-485-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6043207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0105430YPNH01OtherANTHEM
NH30010691Medicaid
0105430YPNH01OtherANTHEM
B86137Medicare UPIN