Healthcare Provider Details

I. General information

NPI: 1023200565
Provider Name (Legal Business Name): NIKITA HEGDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALLEN RD 210
STOW OH
44224-1070
US

IV. Provider business mailing address

4302 ALLEN RD 210
STOW OH
44224-1070
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-7820
  • Fax: 330-928-4320
Mailing address:
  • Phone: 330-344-7820
  • Fax: 330-928-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35-089943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: