Provider Demographics
NPI:1528252822
Name:MOHER, HEATHER (DO)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:MOHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SHAPLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1455
Mailing Address - Country:US
Mailing Address - Phone:207-439-4430
Mailing Address - Fax:207-439-0968
Practice Address - Street 1:22 SHAPLEIGH RD
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1455
Practice Address - Country:US
Practice Address - Phone:207-439-4430
Practice Address - Fax:207-439-0968
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME2141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434817399Medicaid
ME001307001Medicare PIN