Provider Demographics
NPI:1386665321
Name:HEITH, AGNIESZKA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:MARIA
Last Name:HEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LAHEY CLINIC INC
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8000
Mailing Address - Fax:978-921-1254
Practice Address - Street 1:152 CONANT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1600
Practice Address - Country:US
Practice Address - Phone:978-927-1919
Practice Address - Fax:978-921-1254
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA216580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110033820AMedicaid
A35468Medicare ID - Type Unspecified
H85926Medicare UPIN