Healthcare Provider Details

I. General information

NPI: 1073306882
Provider Name (Legal Business Name): ROBERT DAVID BEDFORD JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4134 LANCASTER AVE
PHILADELPHIA PA
19104-1727
US

IV. Provider business mailing address

4134 LANCASTER AVE
PHILADELPHIA PA
19104-1727
US

V. Phone/Fax

Practice location:
  • Phone: 610-477-6423
  • Fax:
Mailing address:
  • Phone: 610-477-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN745947
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: