Provider Demographics
NPI:1235340381
Name:HEGDE, B. V (MD)
Entity Type:Individual
Prefix:DR
First Name:B.
Middle Name:V
Last Name:HEGDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:VASANTHKUMAR
Other - Last Name:HEGDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:908 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3832
Mailing Address - Country:US
Mailing Address - Phone:330-673-3333
Mailing Address - Fax:330-673-7737
Practice Address - Street 1:908 S WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3832
Practice Address - Country:US
Practice Address - Phone:330-673-3333
Practice Address - Fax:330-673-7737
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.034476208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0211998Medicaid