Healthcare Provider Details

I. General information

NPI: 1376738856
Provider Name (Legal Business Name): VERONICA DIANN THOMAS-BEDEAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 09/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 MACARTHUR BLVD NW
WASHINGTON DC
20007-2516
US

IV. Provider business mailing address

12405 PLEASANT PROSPECT RD
MITCHELLVILLE MD
20721-2518
US

V. Phone/Fax

Practice location:
  • Phone: 202-333-9533
  • Fax:
Mailing address:
  • Phone: 301-390-4995
  • Fax: 301-390-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12501
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: