Healthcare Provider Details

I. General information

NPI: 1972626786
Provider Name (Legal Business Name): CHRISTOPHER A. HEATHERTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S MAIN ST
NEWMARKET NH
03857-1843
US

IV. Provider business mailing address

207 S MAIN ST
NEWMARKET NH
03857-1843
US

V. Phone/Fax

Practice location:
  • Phone: 603-659-3106
  • Fax: 603-659-8003
Mailing address:
  • Phone: 603-659-3106
  • Fax: 603-659-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14021
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number14021
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: