Provider Demographics
NPI:1770576688
Name:HEATH, JAMES S (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:HEATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FARLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-5916
Mailing Address - Country:US
Mailing Address - Phone:603-889-2062
Mailing Address - Fax:
Practice Address - Street 1:154 BROAD ST
Practice Address - Street 2:SUITE 1538
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3239
Practice Address - Country:US
Practice Address - Phone:603-889-4431
Practice Address - Fax:603-889-1572
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5692207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH6382OtherCIGNA/HEATHSOURCE ID#
NH783914OtherMVP INSURANCE
NH30002352Medicaid
NH0106484Y0NH01OtherBC/BS#
NH11-04304OtherUNITED HEALTH ID#
NH220013061OtherRAILRAOD MEDICARE
NH005692OtherTUFTS ID#
NH220013061OtherRAILRAOD MEDICARE
NHF04306Medicare UPIN