Provider Demographics
NPI:1417057944
Name:O'BRIEN, HEIDI ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ANN
Other - Last Name:BARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3735
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:115 WATER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3015
Practice Address - Country:US
Practice Address - Phone:508-482-5411
Practice Address - Fax:508-482-5417
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP 1492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP1802Medicare UPIN
AP1802Medicare ID - Type Unspecified