Healthcare Provider Details

I. General information

NPI: 1013930528
Provider Name (Legal Business Name): JOSEPH M BEDNAREK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BATH RD SUITE 208
BRISTOL PA
19007-3101
US

IV. Provider business mailing address

2407 E ALLEGHENY AVE
PHILADELPHIA PA
19134-4402
US

V. Phone/Fax

Practice location:
  • Phone: 215-781-9300
  • Fax: 215-781-9359
Mailing address:
  • Phone: 215-739-2121
  • Fax: 215-739-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD013626E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: