1912965542 NPI number — JOHN D BEDFORD M.D.

Table of content: JOHN D BEDFORD M.D. (NPI 1912965542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912965542 NPI number — JOHN D BEDFORD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEDFORD
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
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:
1912965542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUDLOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01056-0789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-509-1000
Provider Business Mailing Address Fax Number:
413-509-1003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RS CARDIOLOGY & INTERNAL MED.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-532-7760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2006

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: 207R00000X , with the licence number:  160649 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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