Basic Information
| Provider Information | |||||||||
| NPI: | 1659356574 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GINTER | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GINTER | ||||||||
| OtherFirstName: | HEIDI | ||||||||
| OtherMiddleName: | B. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 125 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010853464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135686600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 125 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010853464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135686600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 159349 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | 52615 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207QA0401X | 159349 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207QA0401X | MD19870 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207QA0401X | 16460 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1308785 | 05 | MA | MEDICAID | 1306421 | 05 | MA | MEDICAID | 1301071 | 05 | MA | MEDICAID |