Provider Demographics
NPI:1063500767
Name:HEATON, CARYL JOAN (DO)
Entity Type:Individual
Prefix:
First Name:CARYL
Middle Name:JOAN
Last Name:HEATON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MINES RD # E2
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-6408
Mailing Address - Country:US
Mailing Address - Phone:207-266-9760
Mailing Address - Fax:207-910-6545
Practice Address - Street 1:6 MINES RD # E2
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-6408
Practice Address - Country:US
Practice Address - Phone:207-266-9760
Practice Address - Fax:207-910-6545
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2653207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3744507Medicaid
NJ591484Medicare PIN
NJC02567Medicare UPIN