Healthcare Provider Details

I. General information

NPI: 1043472517
Provider Name (Legal Business Name): JAMES LOUGHLIN HEGARTY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

4144 CHURCH POINT RD
VIRGINIA BEACH VA
23455-7022
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-5283
  • Fax:
Mailing address:
  • Phone: 516-652-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number257378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: