Healthcare Provider Details

I. General information

NPI: 1184800328
Provider Name (Legal Business Name): PABLO BEDOYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 E PARHAM RD STE 210
RICHMOND VA
23294-4306
US

IV. Provider business mailing address

7650 E PARHAM RD STE 210
RICHMOND VA
23294-4306
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-2702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA102914
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101254695
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: