Provider Demographics
NPI:1265433643
Name:HEDGES, PAUL RICHARD (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:HEDGES
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 1:342B TABLE ROCK LANE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-277-5261
Mailing Address - Fax:304-232-7033
Practice Address - Street 1:342B TABLE ROCK LANE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-277-5261
Practice Address - Fax:304-232-7033
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0798212Medicaid
9808COtherHEALTH PLAN OF UPPER OH V
5503570579J30OtherANTHEM BCBS
WV55035705705OtherWV COMPENSATION
WV0075174000Medicaid
WV0075174000Medicaid
OH0798212Medicaid