Provider Demographics
NPI:1437202470
Name:HEIPLE, JEANNE M (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:HEIPLE
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 1:1105 MASSACHUSETTS AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5207
Mailing Address - Country:US
Mailing Address - Phone:617-576-0868
Mailing Address - Fax:
Practice Address - Street 1:1105 MASSACHUSETTS AVE APT 1D
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5207
Practice Address - Country:US
Practice Address - Phone:617-576-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2017-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA736602084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3123081Medicaid
MAJ14772OtherBLUE CROSS BLUE SHIELD
MAJ14772OtherBLUE CROSS BLUE SHIELD
MA3123081Medicaid