Healthcare Provider Details

I. General information

NPI: 1609805068
Provider Name (Legal Business Name): ANN MARIE BEDDOE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800A 5TH AVE SUITE 405
NEW YORK NY
10021-7215
US

IV. Provider business mailing address

800A 5TH AVE SUITE 405
NEW YORK NY
10021-7215
US

V. Phone/Fax

Practice location:
  • Phone: 212-888-8439
  • Fax: 212-319-1140
Mailing address:
  • Phone: 212-888-8439
  • Fax: 212-319-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number140612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: