Provider Demographics
NPI:1720054083
Name:HEIDER, ANGELA LOWE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOWE
Last Name:HEIDER
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 1:1579 W RIVERSTONE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-1012
Mailing Address - Country:US
Mailing Address - Phone:208-435-0788
Mailing Address - Fax:
Practice Address - Street 1:209 E CARVER ST
Practice Address - Street 2:DURHAM WOMENS CLINIC
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-471-2273
Practice Address - Fax:919-479-0881
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-9356101YM0800X
NC200300614207V00000X
IDLCPC9356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127HYMedicaid
NC89127HYMedicaid
H14623Medicare UPIN