Provider Demographics
NPI:1942492970
Name:LINK, HEATHER ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:LINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 S PROSPECT ST
Mailing Address - Street 2:UNIVERSITY PEDIATRICS; UHC CAMPUS REHAB BLDG
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3456
Mailing Address - Country:US
Mailing Address - Phone:802-847-4696
Mailing Address - Fax:802-847-4612
Practice Address - Street 1:1 S PROSPECT ST
Practice Address - Street 2:UNIVERSITY PEDIATRICS; UHC CAMPUS REHAB BLDG
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-847-4696
Practice Address - Fax:802-847-4612
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0012570208000000X
NY245633208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000529552001OtherBCBS
000529552002OtherBCBS
071129000006OtherFIDELIS
000529552003OtherBCBS
1215008OtherIHA
NY02910401Medicaid
071129000005OtherFIDELIS
00028296801OtherUNIVERA
RB6264Medicare PIN