Healthcare Provider Details

I. General information

NPI: 1841901618
Provider Name (Legal Business Name): GABRIEL BREDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVENUE NW DEPT OF CARDIAC INTENSIVE CARE
WASHINGTON DC
20010
US

IV. Provider business mailing address

4 KINNERSLEY COURT EDGWAREBURY LANE
EDGWARE MIDDLESEX
HA88LR
GB

V. Phone/Fax

Practice location:
  • Phone: 202-476-6533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD210002953
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: