Provider Demographics
NPI:1649616319
Name:HEISE, CLAUDIA WINOGRAD (MD PHD)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:WINOGRAD
Last Name:HEISE
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:
Other - Last Name:WINOGRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:20 MUSSEY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9570
Mailing Address - Country:US
Mailing Address - Phone:207-885-1333
Mailing Address - Fax:207-885-1337
Practice Address - Street 1:20 MUSSEY RD
Practice Address - Street 2:STE 2
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9570
Practice Address - Country:US
Practice Address - Phone:207-535-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine