Provider Demographics
NPI:1558988527
Name:HEDDY, MERRILL BENJAMIN (DPM)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:BENJAMIN
Last Name:HEDDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2132
Mailing Address - Country:US
Mailing Address - Phone:585-343-8190
Mailing Address - Fax:585-343-1768
Practice Address - Street 1:2 STATE ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2132
Practice Address - Country:US
Practice Address - Phone:585-343-8190
Practice Address - Fax:585-343-1768
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007337213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist