Provider Demographics
NPI:1386600815
Name:HELLER, DAVID R (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:HELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:333 BORTHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-433-4012
Mailing Address - Fax:603-433-5184
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-4012
Practice Address - Fax:603-433-5184
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH7725207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH930118730OtherRAILROAD
NH0408874Y0NH02OtherANTHEM
ME240600099Medicaid
NH0408874Y0NH01OtherBCBS OF NH
MA3164519Medicaid
NH30220411Medicaid
930118730OtherRAILROAD MEDICARE
ME240600099Medicaid
NHUX4281Medicare PIN
NHRE1003Medicare PIN