Provider Demographics
NPI:1386665321
Name:HEITH, AGNIESZKA MARIA (MD)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:MARIA
Last Name:HEITH
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 1:370 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1788
Mailing Address - Country:US
Mailing Address - Phone:978-241-3615
Mailing Address - Fax:978-557-8798
Practice Address - Street 1:152 CONANT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1600
Practice Address - Country:US
Practice Address - Phone:978-927-1919
Practice Address - Fax:978-921-1254
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110033820AMedicaid
A35468Medicare ID - Type Unspecified
H85926Medicare UPIN