Healthcare Provider Details

I. General information

NPI: 1649211434
Provider Name (Legal Business Name): JOEL M HEGARTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 BAGLEY RD
MIDDLEBURG HEIGHTS OH
44130-3417
US

IV. Provider business mailing address

18697 BAGLEY RD
MIDDLEBURG HEIGHTS OH
44130-3417
US

V. Phone/Fax

Practice location:
  • Phone: 440-816-6246
  • Fax: 440-816-6263
Mailing address:
  • Phone: 440-816-6246
  • Fax: 440-816-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.060339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: