Provider Demographics
NPI:1407166861
Name:HEBBAR, VIDYA RANGARAJ (PHD, RPH)
Entity Type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:RANGARAJ
Last Name:HEBBAR
Suffix:
Gender:F
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6436 SWIMMER ROW WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4962
Mailing Address - Country:US
Mailing Address - Phone:585-217-9442
Mailing Address - Fax:
Practice Address - Street 1:985 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2905
Practice Address - Country:US
Practice Address - Phone:585-872-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24599183500000X
NY054626-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist