Provider Demographics
NPI:1104029917
Name:HEDGE, JOHN FULTON (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FULTON
Last Name:HEDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD
Mailing Address - Street 2:250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3705 OLENTANGY RIVER RD
Practice Address - Street 2:STE 260
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3467
Practice Address - Country:US
Practice Address - Phone:614-533-6600
Practice Address - Fax:614-533-6609
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1088207Q00000X, 207QS0010X
NC200600893207Q00000X, 207QS0010X
OH34008458207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916171Medicaid
SC010883Medicaid
SCP00436180OtherRAILROAD MEDICARE PTAN
OHPENDINGMedicaid
SC1088OtherMEDICAL LICENSE
NC5916171Medicaid
SC010883Medicaid
SCAA22687180Medicare PIN
NC2076812Medicare PIN
SCAA22688851Medicare PIN
OHPENDINGMedicare PIN