Healthcare Provider Details

I. General information

NPI: 1760290530
Provider Name (Legal Business Name): JOANN HEGBE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SECURITY BLVD STE 200
BALTIMORE MD
21244-2412
US

IV. Provider business mailing address

6901 SECURITY BLVD STE 200
BALTIMORE MD
21244-2412
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-2050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009778
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: