Healthcare Provider Details

I. General information

NPI: 1205207172
Provider Name (Legal Business Name): HEATHER E BIGOS P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 CENTRAL AVE
DOVER NH
03820-2549
US

IV. Provider business mailing address

784 CENTRAL AVE
DOVER NH
03820-2549
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-5556
  • Fax:
Mailing address:
  • Phone: 603-742-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA173714
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: