Healthcare Provider Details

I. General information

NPI: 1528184439
Provider Name (Legal Business Name): BEDFORD PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ROUTE 101 UNIT 7B
BEDFORD NH
03110-5030
US

IV. Provider business mailing address

360 ROUTE 101 UNIT 7B
BEDFORD NH
03110-5030
US

V. Phone/Fax

Practice location:
  • Phone: 603-471-0831
  • Fax: 603-471-0890
Mailing address:
  • Phone: 603-471-0831
  • Fax: 603-471-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KERMIT BRUNELLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 603-471-0831