Provider Demographics
NPI:1760417752
Name:HEDGEPETH, JAMES RANDY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RANDY
Last Name:HEDGEPETH
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 1:1921 FALLS VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-872-0250
Mailing Address - Fax:919-848-3137
Practice Address - Street 1:1405 TIMBER DR E
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6926
Practice Address - Country:US
Practice Address - Phone:919-779-6423
Practice Address - Fax:919-662-2021
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F45214Medicare UPIN