Provider Demographics
NPI:1598946709
Name:KENNETH A. HEISLER, M.D.P.C.
Entity Type:Organization
Organization Name:KENNETH A. HEISLER, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:HEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-548-8317
Mailing Address - Street 1:78 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2692
Mailing Address - Country:US
Mailing Address - Phone:508-548-8317
Mailing Address - Fax:
Practice Address - Street 1:78 MAIN ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2692
Practice Address - Country:US
Practice Address - Phone:508-548-8317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9728635Medicaid
MAM13557OtherBC/BS
MAM13557OtherBC/BS