Provider Demographics
NPI:1104712900
Name:HEDGEMOND, MARCUS
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:HEDGEMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19109 LUEDTKE LN
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5021
Mailing Address - Country:US
Mailing Address - Phone:215-498-8310
Mailing Address - Fax:
Practice Address - Street 1:19109 LUEDTKE LN
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5021
Practice Address - Country:US
Practice Address - Phone:215-498-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach