Healthcare Provider Details

I. General information

NPI: 1699466409
Provider Name (Legal Business Name): BEDFORD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NORTH RD STE 200
BEDFORD MA
01730-1037
US

IV. Provider business mailing address

41 NORTH RD STE 200
BEDFORD MA
01730-1037
US

V. Phone/Fax

Practice location:
  • Phone: 781-275-5437
  • Fax: 781-275-6212
Mailing address:
  • Phone: 781-275-5437
  • Fax: 781-275-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID S GELLER
Title or Position: PRINCIPAL OWNER
Credential: MD
Phone: 781-275-5437