Provider Demographics
NPI:1659356574
Name:GINTER, HEIDI (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:GINTER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:B
Other - Last Name:GINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2803
Mailing Address - Country:US
Mailing Address - Phone:508-941-7920
Mailing Address - Fax:
Practice Address - Street 1:360 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2186
Practice Address - Country:US
Practice Address - Phone:508-894-0575
Practice Address - Fax:508-941-6446
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16460207QA0401X
MA159349207QA0401X, 207Q00000X
CT52615207QA0401X
MEMD19870207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308785Medicaid
MA1306421Medicaid
MA1301071Medicaid
MA1306421Medicaid
MA1308785Medicaid
MA1301071Medicaid