MEDICARE: DR. IRA T KEDSON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS-008236-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	951263	OTHER	PA	HIGHMARK BC/BS IDENTIFIER

General Provider Information

NPI Number	:	1588627863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA T KEDSON PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 1264
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-8264
Country	:	US
Telephone Number	:	610-325-7792
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S CHESTER RD STE 4
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1919
Country	:	US
Telephone Number	:	610-325-7792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	08/19/2025

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