Healthcare Provider Details

I. General information

NPI: 1205332483
Provider Name (Legal Business Name): BRYCE XAVIER BREDELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HALKET ST
PITTSBURGH PA
15213-3108
US

IV. Provider business mailing address

300 HALKET ST
PITTSBURGH PA
15213-3108
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-4190
  • Fax: 412-864-3400
Mailing address:
  • Phone: 734-645-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301504086
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD477052
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: