Provider Demographics
NPI:1679575666
Name:COATES-KRAWITZ, HEATHER E (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:E
Last Name:COATES-KRAWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:E
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:19 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-2709
Mailing Address - Country:US
Mailing Address - Phone:617-394-7500
Mailing Address - Fax:617-394-7576
Practice Address - Street 1:19 NORWOOD ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-2709
Practice Address - Country:US
Practice Address - Phone:617-394-7500
Practice Address - Fax:617-394-7576
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232662208000000X, 207R00000X
MA233887207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02614620Medicaid
NY02614620Medicaid
H21127Medicare UPIN