Provider Demographics
NPI:1558380600
Name:PETERSON, HEIDI HABICHT (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:HABICHT
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:HABICHT
Other - Last Name:BROWNLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703
Mailing Address - Country:US
Mailing Address - Phone:508-761-5650
Mailing Address - Fax:508-761-9870
Practice Address - Street 1:230 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703
Practice Address - Country:US
Practice Address - Phone:508-761-5650
Practice Address - Fax:508-761-9870
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159941207Q00000X
RIMD11077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0020858OtherNEIGHBORHOOD HEALTHCARE
RI410071OtherBLUE CHIP
MA3200302Medicaid
MA711511OtherHARVARD HEALTHCARE
MAJ25000OtherMASS BLUE CROSS
RI159941OtherTUFTS HEALTH PLAN
RIHB53533Medicaid
RI26483OtherRHODE ISLAND BLUE CROSS/
MAJ25000OtherMASS BLUE CROSS
A30757Medicare PIN