Provider Demographics
NPI:1346431376
Name:DODDS, HEATHER LEA (MD)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LEA
Last Name:DODDS
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 1:1028 BOULEVARD
Mailing Address - Street 2:#230
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1801
Mailing Address - Country:US
Mailing Address - Phone:860-836-5961
Mailing Address - Fax:
Practice Address - Street 1:1028 BOULEVARD
Practice Address - Street 2:#230
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1801
Practice Address - Country:US
Practice Address - Phone:860-836-5961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239537207P00000X
ORMD28539207P00000X
CT046168207P00000X
ME018257207P00000X
RIMD13232207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIHD81694Medicaid