Provider Demographics
NPI:1780697052
Name:HEGEDUS, CHARLES EDWIN
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWIN
Last Name:HEGEDUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9199 STAPLES MILL RD
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2027
Mailing Address - Country:US
Mailing Address - Phone:804-672-1222
Mailing Address - Fax:804-672-3269
Practice Address - Street 1:9199 STAPLES MILL RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2027
Practice Address - Country:US
Practice Address - Phone:804-672-1222
Practice Address - Fax:804-672-3269
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA262340OtherANTHEM
VA262340OtherANTHEM
VA350000919Medicare ID - Type Unspecified