Provider Demographics
NPI:1992797518
Name:HEDE, VIDYADHAR S (MD)
Entity type:Individual
Prefix:DR
First Name:VIDYADHAR
Middle Name:S
Last Name:HEDE
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 1:9323 PINECROFT DR.
Mailing Address - Street 2:STE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3260
Mailing Address - Country:US
Mailing Address - Phone:281-296-0669
Mailing Address - Fax:281-681-2344
Practice Address - Street 1:9323 PINECROFT DR
Practice Address - Street 2:STE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3260
Practice Address - Country:US
Practice Address - Phone:281-296-0669
Practice Address - Fax:281-681-2344
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2218207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122350504Medicaid
TX122350504Medicaid
00824LMedicare ID - Type Unspecified