Provider Demographics
NPI:1326225301
Name:HEDGEPETH, RYAN CHADLER (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CHADLER
Last Name:HEDGEPETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 THOMAS LN
Practice Address - Street 2:SUITE 3G
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3902
Practice Address - Country:US
Practice Address - Phone:614-788-2870
Practice Address - Fax:614-533-0177
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089863208800000X
LAMD.205910208800000X
OH35.086048208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09002792Medicaid
LA2322087Medicaid
OHH427710Medicare PIN
LA267990YH3UMedicare PIN