Healthcare Provider Details

I. General information

NPI: 1366285173
Provider Name (Legal Business Name): MARY BEDZYK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UBMD EMERGENCY MEDICINE, 77 GOODELL STREET SUITE 340
BUFFALO NY
14203
US

IV. Provider business mailing address

UBMD EMERGENCY MEDICINE, 77 GOODELL STREET SUITE 340
BUFFALO NY
14203
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: