Healthcare Provider Details

I. General information

NPI: 1700723541
Provider Name (Legal Business Name): MARIAM BEDOIDZE ASSOCIATE DEGREE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 E CONESTOGA RD
WAYNE PA
19087-2509
US

IV. Provider business mailing address

622 NORLYN CT
KING OF PRUSSIA PA
19406-3059
US

V. Phone/Fax

Practice location:
  • Phone: 215-900-1681
  • Fax:
Mailing address:
  • Phone: 215-900-1681
  • Fax: 215-876-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number26173601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: