Provider Demographics
NPI:1225202237
Name:HEATON, KEVIN D (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
Last Name:HEATON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 TURNPIKE ST STE 21
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5937
Mailing Address - Country:US
Mailing Address - Phone:978-794-1946
Mailing Address - Fax:978-794-2342
Practice Address - Street 1:62 BROWN ST STE 303
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6790
Practice Address - Country:US
Practice Address - Phone:978-794-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245591207Q00000X, 207QS0010X
NH15345207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077761Medicaid
NH3077761Medicaid