Healthcare Provider Details

I. General information

NPI: 1235828526
Provider Name (Legal Business Name): BEDICCAA MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 FORBES BLVD STE D
LANHAM MD
20706-4882
US

IV. Provider business mailing address

4850 FORBES BLVD STE D
LANHAM MD
20706-4882
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-5667
  • Fax: 301-459-7059
Mailing address:
  • Phone: 301-459-5667
  • Fax: 301-459-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDITH N ARAH
Title or Position: PRESIDENT
Credential: FNP
Phone: 240-481-8126