Healthcare Provider Details

I. General information

NPI: 1659356574
Provider Name (Legal Business Name): HEIDI GINTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI B. GINTER M.D.

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 QUINCY AVE
BROCKTON MA
02302-2803
US

IV. Provider business mailing address

176 QUINCY AVE
BROCKTON MA
02302-2803
US

V. Phone/Fax

Practice location:
  • Phone: 508-894-0575
  • Fax: 508-941-6446
Mailing address:
  • Phone: 508-948-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number159349
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number16460
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number52615
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD19870
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number159349
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: