Provider Demographics
NPI:1518955251
Name:HEDRICK, JR, RICHARD ELI (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ELI
Last Name:HEDRICK, JR
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 1:1806 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4014
Mailing Address - Country:US
Mailing Address - Phone:336-768-3632
Mailing Address - Fax:336-768-4473
Practice Address - Street 1:1806 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4014
Practice Address - Country:US
Practice Address - Phone:336-768-3632
Practice Address - Fax:336-768-4473
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26753207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8941083Medicaid
NC8941083Medicaid
NC202890CMedicare ID - Type Unspecified