Provider Demographics
NPI:1194745737
Name:HEDDERMAN, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HEDDERMAN
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 1:1367 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1043
Mailing Address - Country:US
Mailing Address - Phone:518-489-2666
Mailing Address - Fax:518-489-5933
Practice Address - Street 1:1367 WASHINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1043
Practice Address - Country:US
Practice Address - Phone:518-489-2666
Practice Address - Fax:518-489-5933
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161357-9207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01184674Medicaid
NY18127OtherMVP
NY4577474OtherAETNA
NY75F361OtherEMPIRE BLUE CROSS
NY000405988001OtherBS NENY
NY10000864OtherCDPHP
NY000405988001OtherBS NENY
NY75F361OtherEMPIRE BLUE CROSS
NY01184674Medicaid