MEDICARE: DR. EDWARD BEDRICK 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	207R00000X	Internal Medicine Physician	MD025011E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	597586	OTHER	PA	TPI GROUP MEDICARE PTAN
6	CD4829	OTHER	PA	TPI GROUP RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	418283	OTHER		BLUE SHIELD
2	1047802	OTHER		KEYSTONE MERCY
4	0054706000	OTHER	PA	KEYSTONE
5	0000642	OTHER	PA	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861434201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD BEDRICK M.D.

Provider Business Mailing Address
First Line	:	7500 CENTRAL AVE
Second Line	:	SUITE 104
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2430
Country	:	US
Telephone Number	:	215-742-0712
Fax Number	:	215-742-5218

Provider Business Practice Location Address
First Line	:	7500 CENTRAL AVE
Second Line	:	SUITE 104
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2430
Country	:	US
Telephone Number	:	215-742-0712
Fax Number	:	215-742-5218

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	10/01/2012

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Directions to “ DR. EDWARD BEDRICK M.D.” Practice Location

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