Provider Demographics
NPI:1437149028
Name:GAISSERT, HENNING A (MD)
Entity Type:Individual
Prefix:DR
First Name:HENNING
Middle Name:A
Last Name:GAISSERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-5341
Mailing Address - Fax:617-726-7667
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BLK 1570
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-5341
Practice Address - Fax:617-726-7667
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60405208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ12053OtherBCBS MA
MA724283OtherTUFTS HEALTH PLAN
MA3085708Medicaid
MA3085708Medicaid
MAJ12053OtherBCBS MA