Provider Demographics
NPI:1043223860
Name:BEDRICK, TRICIA N (DO)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:N
Last Name:BEDRICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 STATE RD STE F
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1400
Mailing Address - Country:US
Mailing Address - Phone:330-926-1955
Mailing Address - Fax:330-926-1956
Practice Address - Street 1:1860 STATE RD
Practice Address - Street 2:SUITE F
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1400
Practice Address - Country:US
Practice Address - Phone:330-926-1955
Practice Address - Fax:330-926-1956
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2634715Medicaid
OHBE4176031Medicare ID - Type Unspecified
OHI48060Medicare UPIN