Healthcare Provider Details

I. General information

NPI: 1881687341
Provider Name (Legal Business Name): LUCIAN P. BEDNARZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MORGAN HWY SUITE 4
SCRANTON PA
18508-2641
US

IV. Provider business mailing address

5 MORGAN HWY SUITE 4
SCRANTON PA
18508-2641
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-3788
  • Fax: 570-969-9280
Mailing address:
  • Phone: 570-344-3788
  • Fax: 570-969-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD054459L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier545626
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CARE
# 2
Identifier2252156
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 3
Identifier001598910-0004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier20038442
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERIHEALTH
# 5
Identifier50075037
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 6
Identifier140004801
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 7
Identifier22387-1067
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGEISINGER
# 8
Identifier804214
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CARE HMO (FPH)

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: