Healthcare Provider Details

I. General information

NPI: 1598226599
Provider Name (Legal Business Name): ROBERT STEPHEN BEDENBAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 W. 10TH AVE 774 PRIOR HALL
COLUMBUS OH
43210-1280
US

IV. Provider business mailing address

2951 MAPLE AVE
ZANESVILLE OH
43701-1406
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.14443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: