Healthcare Provider Details

I. General information

NPI: 1144512161
Provider Name (Legal Business Name): CHRISTOPHER THOMAS BEDNAREK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SANDPIPER CIR SUITE 210
NOTTINGHAM MD
21236-4991
US

IV. Provider business mailing address

2 PARK CENTER CT SUITE 200
OWINGS MILLS MD
21117-4295
US

V. Phone/Fax

Practice location:
  • Phone: 443-693-7246
  • Fax:
Mailing address:
  • Phone: 443-693-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD456310
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD80197
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: