Provider Demographics
NPI:1033115175
Name:HEISKELL, ERIN F (MD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:F
Last Name:HEISKELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HARBOR VIEW TER
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5305
Mailing Address - Country:US
Mailing Address - Phone:978-744-0893
Mailing Address - Fax:
Practice Address - Street 1:130 COUNTY RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2585
Practice Address - Country:US
Practice Address - Phone:978-356-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2017334Medicaid
MAH65289Medicare UPIN
MA2017334Medicaid