Provider Demographics
NPI:1255313334
Name:HEIST, EDWIN KEVIN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:KEVIN
Last Name:HEIST
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-4959
Mailing Address - Fax:617-726-3852
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 109 CARDIAC UNIT ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-8514
Practice Address - Fax:617-726-7519
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA205118207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA466508OtherTUFTS HEALTH PLAN
MAJ27293OtherBCBS MA
MA2041961Medicaid
MASX2719Medicare PIN
MAJ27293OtherBCBS MA