Provider Demographics
NPI:1457336216
Name:FERRILL, HEATHER P (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:P
Last Name:FERRILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:PO BOX 626
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-284-6291
Practice Address - Street 1:655 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072
Practice Address - Country:US
Practice Address - Phone:207-283-1407
Practice Address - Fax:207-284-6291
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1712204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME413340099Medicaid
MEME088901Medicare PIN
ME413340099Medicaid