Healthcare Provider Details

I. General information

NPI: 1457685653
Provider Name (Legal Business Name): GABRIELLA BEDARIDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOWE ST
NEW HAVEN CT
06511-5473
US

IV. Provider business mailing address

256 MCKINLEY AVE
NEW HAVEN CT
06515-2012
US

V. Phone/Fax

Practice location:
  • Phone: 203-215-6988
  • Fax: 203-401-0335
Mailing address:
  • Phone: 203-215-6988
  • Fax: 203-401-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number045217
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: