Healthcare Provider Details

I. General information

NPI: 1588843866
Provider Name (Legal Business Name): BEDILU W WOLDAREGAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 TUCK ST
LEBANON PA
17042
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 171-272-8173
  • Fax: 717-272-4029
Mailing address:
  • Phone: 717-272-8173
  • Fax: 717-272-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD464573
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: