Healthcare Provider Details

I. General information

NPI: 1689630527
Provider Name (Legal Business Name): NATALIA STAR HEGEDOSH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 EAST HALLANDALE BEACH BLVD SUITE 400
HALLANDALE FL
33009
US

IV. Provider business mailing address

2500 E HALLANDALE BEACH BLVD SUITE 400
HALLANDALE BEACH FL
33009-4834
US

V. Phone/Fax

Practice location:
  • Phone: 954-456-4777
  • Fax: 954-456-6777
Mailing address:
  • Phone: 964-467-4777
  • Fax: 954-456-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD428283
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME102158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: