Provider Demographics
NPI:1063409233
Name:HEDGEPETH, CHESTER MELVIN (MD)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:MELVIN
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 1:1 PEARL ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2864
Mailing Address - Country:US
Mailing Address - Phone:508-897-6090
Mailing Address - Fax:508-897-6075
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-897-6090
Practice Address - Fax:508-897-6075
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216367207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I40099Medicare UPIN
MAA39091Medicare ID - Type Unspecified