Healthcare Provider Details

I. General information

NPI: 1689896136
Provider Name (Legal Business Name): HEIKE ROLLE-DAYA, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WOODLAND ROAD SUITE 205
STONEHAM MA
02180-1710
US

IV. Provider business mailing address

3 WOODLAND ROAD SUITE 205
STONEHAM MA
02180-1710
US

V. Phone/Fax

Practice location:
  • Phone: 781-662-2100
  • Fax: 781-662-7807
Mailing address:
  • Phone: 781-662-2100
  • Fax: 781-662-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2027321
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier2035472
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 3
Identifier1346231883
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNPI - HEIKE ROLLE-DAYA
# 4
Identifier1780675231
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNPI - KANTA NAGPAUL

VIII. Authorized Official

Name: MS. NANCY ENOS
Title or Position: OFFICE MANAGER
Credential:
Phone: 781-662-2100