Provider Demographics
NPI:1194805804
Name:ANN E HEDBERG MD PLC
Entity type:Organization
Organization Name:ANN E HEDBERG MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-589-6358
Mailing Address - Street 1:PO BOX 21859
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0602
Mailing Address - Country:US
Mailing Address - Phone:540-589-6358
Mailing Address - Fax:815-366-8271
Practice Address - Street 1:4045 POSTAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6439
Practice Address - Country:US
Practice Address - Phone:540-589-6358
Practice Address - Fax:815-366-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09939Medicare PIN
DF9894Medicare PIN