Provider Demographics
NPI:1689614505
Name:HEDRICK, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:HEDRICK
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 1:129 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4434
Mailing Address - Country:US
Mailing Address - Phone:828-258-8800
Mailing Address - Fax:828-281-7178
Practice Address - Street 1:60 LIVINGSTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4402
Practice Address - Country:US
Practice Address - Phone:828-258-8800
Practice Address - Fax:828-281-7178
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400834207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8940938Medicaid
NC40938OtherBCBS
NC8940938Medicaid
NC2202163Medicare PIN
NC200022956Medicare PIN