Provider Demographics
NPI:1689630527
Name:HEGEDOSH, NATALIA STAR (MD)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:STAR
Last Name:HEGEDOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4834
Mailing Address - Country:US
Mailing Address - Phone:964-467-4777
Mailing Address - Fax:954-456-6777
Practice Address - Street 1:2500 EAST HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-456-4777
Practice Address - Fax:954-456-6777
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428283207Q00000X
FLME102158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000598200Medicaid
FLBH857ZMedicare PIN