Provider Demographics
NPI:1073306882
Name:BEDFORD, ROBERT DAVID JR (RN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAVID
Last Name:BEDFORD
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1727
Mailing Address - Country:US
Mailing Address - Phone:610-477-6423
Mailing Address - Fax:
Practice Address - Street 1:4134 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1727
Practice Address - Country:US
Practice Address - Phone:610-477-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN745947163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice