MEDICARE: DR. HEATHER E GOTHA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	14592	RI
2	207X00000X	Orthopaedic Surgery Physician	C10011802	DE
3	207X00000X	Orthopaedic Surgery Physician	19805	NH
4	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	283806	MA
5	207X00000X	Orthopaedic Surgery Physician	283806	MA

General Provider Information

NPI Number	:	1669600920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER E GOTHA MD

Provider Business Mailing Address
First Line	:	1 MEDICAL CENTER DR
Second Line	:
City	:	LEBANON
State	:	NH
Zip	:	03756-0001
Country	:	US
Telephone Number	:	603-650-5133
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 BIRNIE AVE STE 201
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-1121
Country	:	US
Telephone Number	:	413-785-4666
Fax Number	:	413-846-4756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	04/30/2024

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