Provider Demographics
NPI:1447322284
Name:HEIDERSCHEIDT, BENEDICT GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:GERALD
Last Name:HEIDERSCHEIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:21 CAVERNO DR
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:NH
Mailing Address - Zip Code:03861-6630
Mailing Address - Country:US
Mailing Address - Phone:603-988-8128
Mailing Address - Fax:610-340-9130
Practice Address - Street 1:21 CAVERNO DR
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:NH
Practice Address - Zip Code:03861-6630
Practice Address - Country:US
Practice Address - Phone:603-988-8128
Practice Address - Fax:610-340-9130
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NHNH11501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine