Healthcare Provider Details

I. General information

NPI: 1386600815
Provider Name (Legal Business Name): DAVID R HELLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 01/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVE
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

333 BORTHWICK AVE
PORTSMOUTH NH
03801-7128
US

V. Phone/Fax

Practice location:
  • Phone: 603-433-4012
  • Fax: 603-433-5184
Mailing address:
  • Phone: 603-433-4012
  • Fax: 603-433-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number7725
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: