Healthcare Provider Details

I. General information

NPI: 1588123780
Provider Name (Legal Business Name): EMMA ROSE MILLER-BEDELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

20 WILLETT ST APT 3
ALBANY NY
12210-1184
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8000
  • Fax:
Mailing address:
  • Phone: 845-729-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA179774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: