Healthcare Provider Details

I. General information

NPI: 1548209125
Provider Name (Legal Business Name): ANDREW BEDFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 MAIN ST
STRATFORD CT
06614-4980
US

IV. Provider business mailing address

2890 MAIN ST
STRATFORD CT
06614-4980
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-1200
  • Fax: 203-378-2412
Mailing address:
  • Phone: 203-375-1200
  • Fax: 203-378-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036902
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: