Provider Demographics
NPI:1275512816
Name:HEGARTY, MARY (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HEGARTY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOSPITAL DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9362
Mailing Address - Country:US
Mailing Address - Phone:570-523-8700
Mailing Address - Fax:570-513-8705
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:SUITE 312
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9362
Practice Address - Country:US
Practice Address - Phone:570-523-8700
Practice Address - Fax:570-513-8705
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP 001766G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014114JREMedicare ID - Type Unspecified
PAS637409Medicare UPIN