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General NPI Number Information
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NPI Number | 1558380600
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Entity Type | Individual
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Provider Name | HEIDI HABICHT PETERSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 230 WASHINGTON STREET
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City | SOUTH ATTLEBORO
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State | MA
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Zip | 02703
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Country | US
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Telephone | 508-761-5650
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Fax | 508-761-9870
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Provider Business Mailing Address
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Address Line | 230 WASHINGTON STREET
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City | SOUTH ATTLEBORO
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State | MA
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Zip | 02703
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Country | US
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Telephone | 508-761-5650
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Fax | 508-761-9870
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 159941
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD11077
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License Number State | RI
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