Healthcare Provider Details

I. General information

NPI: 1285389189
Provider Name (Legal Business Name): MARK JAMES HEDINGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 1005 BOX 110185
FPO AA
34009
US

IV. Provider business mailing address

NAVY HOSPITAL GUANTANAMO BAY PSC 1005, BOX 110185
FPO AA
34009
US

V. Phone/Fax

Practice location:
  • Phone: 757-458-2360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A21665
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A21665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: