Provider Demographics
NPI:1508856287
Name:HELLER, HOWARD MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARK
Last Name:HELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MASSACHUSETTS AVE
Mailing Address - Street 2:E 23 MASSACHUSETTS INSITUTE OF TECHNOLOGY
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4301
Mailing Address - Country:US
Mailing Address - Phone:617-253-1615
Mailing Address - Fax:617-258-0437
Practice Address - Street 1:77 MASSACHUSETTS AVE
Practice Address - Street 2:E 23 MASSACHUSETTS INSITUTE OF TECHNOLOGY
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4301
Practice Address - Country:US
Practice Address - Phone:617-253-1615
Practice Address - Fax:617-258-0437
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74425207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3080935Medicaid
MAJ11283OtherBCBS MA
MA074425OtherTUFTS HEALTH PLAN
MA074425OtherTUFTS HEALTH PLAN
MAJ11283Medicare ID - Type Unspecified