Healthcare Provider Details

I. General information

NPI: 1558380600
Provider Name (Legal Business Name): HEIDI HABICHT PETERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI HABICHT BROWNLIE

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 WASHINGTON STREET
SOUTH ATTLEBORO MA
02703
US

IV. Provider business mailing address

230 WASHINGTON STREET
SOUTH ATTLEBORO MA
02703
US

V. Phone/Fax

Practice location:
  • Phone: 508-761-5650
  • Fax: 508-761-9870
Mailing address:
  • Phone: 508-761-5650
  • Fax: 508-761-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number159941
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD11077
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: