Provider Demographics
NPI:1184697278
Name:HEIST, REBECCA SUK (MD MPH)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUK
Last Name:HEIST
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:DR
Other - First Name:CHI-WON
Other - Middle Name:REBECCA
Other - Last Name:SUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MPH
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-4000
Mailing Address - Fax:617-726-0453
Practice Address - Street 1:32 FRUIT ST
Practice Address - Street 2:YAWKEY 7B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2620
Practice Address - Country:US
Practice Address - Phone:617-724-4000
Practice Address - Fax:617-726-0453
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468219OtherTUFTS HEALTH PLAN
MA2104148Medicaid
MAJ28696OtherBCBS MA
MA2104148Medicaid
MA468219OtherTUFTS HEALTH PLAN