Provider Demographics
NPI:1578664769
Name:HEGDE, BELANJE SUDHAKARA (MD)
Entity Type:Individual
Prefix:MR
First Name:BELANJE
Middle Name:SUDHAKARA
Last Name:HEGDE
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 1:7776 EVENING STAR LANE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3555
Mailing Address - Country:US
Mailing Address - Phone:850-893-8920
Mailing Address - Fax:850-893-0144
Practice Address - Street 1:7776 EVENING STAR LANE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3555
Practice Address - Country:US
Practice Address - Phone:850-893-8920
Practice Address - Fax:850-893-0144
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL236292085R0202X
GA0199522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308539500Medicaid
E59891Medicare UPIN
FL308539500Medicaid