Provider Demographics
NPI:1669600920
Name:GOTHA, HEATHER E (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:E
Last Name:GOTHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-5133
Mailing Address - Fax:
Practice Address - Street 1:300 BIRNIE AVE STE 201
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1121
Practice Address - Country:US
Practice Address - Phone:413-785-4666
Practice Address - Fax:413-846-4756
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI14592207X00000X
DEC10011802207X00000X
NH19805207X00000X
MA283806207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery