MEDICARE: DR. JOHN WYCLIFF BEDEAU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	D30666	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487646154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WYCLIFF BEDEAU M.D.

Provider Business Mailing Address
First Line	:	9301 LARGO DRIVE WEST
Second Line	:	SUITE 201
City	:	LARGO
State	:	MD
Zip	:	20774-4884
Country	:	US
Telephone Number	:	301-350-8722
Fax Number	:	301-350-8822

Provider Business Practice Location Address
First Line	:	9301 LARGO DRIVE WEST
Second Line	:	SUITE 201
City	:	LARGO
State	:	MD
Zip	:	20774-4884
Country	:	US
Telephone Number	:	301-350-8722
Fax Number	:	301-350-8822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	03/11/2026

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Directions to “ DR. JOHN WYCLIFF BEDEAU M.D.” Practice Location

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