Healthcare Provider Details

I. General information

NPI: 1457335739
Provider Name (Legal Business Name): JUDITH IRENE HEGARTY M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5262 WOODS RD
CAMBRIDGE MD
21613-3796
US

IV. Provider business mailing address

8275 MUELLER DRIVE
EASTON MD
21601
US

V. Phone/Fax

Practice location:
  • Phone: 410-221-3558
  • Fax: 410-221-2497
Mailing address:
  • Phone: 410-819-3749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0038090
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: