1588843866 NPI number — DR. BEDILU W WOLDAREGAY M.D.

Table of content: DR. BEDILU W WOLDAREGAY M.D. (NPI 1588843866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588843866 NPI number — DR. BEDILU W WOLDAREGAY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLDAREGAY
Provider First Name:
BEDILU
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588843866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3421 CONCORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-272-8173
Provider Business Mailing Address Fax Number:
717-272-4029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 TUCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
171-272-8173
Provider Business Practice Location Address Fax Number:
717-272-4029
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  MD464573 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588843866 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 645046 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 46589035 . This is a "BCBS OF KS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 681522 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 133114 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 46589025 . This is a "BCBS OF KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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