Healthcare Provider Details

I. General information

NPI: 1154521771
Provider Name (Legal Business Name): EDUARDO T BERDECIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 07/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COURT ST
LYNCHBURG VA
24504-1312
US

IV. Provider business mailing address

620 COURT ST
LYNCHBURG VA
24504-1312
US

V. Phone/Fax

Practice location:
  • Phone: 434-455-2082
  • Fax:
Mailing address:
  • Phone: 434-455-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number0101242163
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: