Provider Demographics
NPI:1467644096
Name:VICKI HELLER, MD/GENTLE GYNECOLOGY
Entity Type:Organization
Organization Name:VICKI HELLER, MD/GENTLE GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-398-0038
Mailing Address - Street 1:808 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-8533
Mailing Address - Country:US
Mailing Address - Phone:781-398-0038
Mailing Address - Fax:
Practice Address - Street 1:808 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-8533
Practice Address - Country:US
Practice Address - Phone:781-398-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58204207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty