Provider Demographics
NPI:1184736381
Name:ROOT, HEIDI (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6130
Mailing Address - Country:US
Mailing Address - Phone:603-447-3500
Mailing Address - Fax:603-447-5568
Practice Address - Street 1:7 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6130
Practice Address - Country:US
Practice Address - Phone:603-447-3500
Practice Address - Fax:603-447-5568
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH163850OtherCIGNA
NH30006474Medicaid
NH0106216Y0NH01OtherANTHEM BCBS
E51351Medicare UPIN
NH0106216Y0NH01OtherANTHEM BCBS