Healthcare Provider Details

I. General information

NPI: 1184605958
Provider Name (Legal Business Name): PETRA HEIKE STEINBUCHEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OLD LANTERN LN # B
GROTON MA
01450-2201
US

IV. Provider business mailing address

15 OLD LANTERN LN # B
GROTON MA
01450-2201
US

V. Phone/Fax

Practice location:
  • Phone: 617-233-3048
  • Fax:
Mailing address:
  • Phone: 617-233-3048
  • Fax: 617-726-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number224031
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA82452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: