Provider Demographics
NPI:1083868905
Name:BEDNARSKI, BROOKE NICOLE BOSLEY (MD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE BOSLEY
Last Name:BEDNARSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:NICOLE
Other - Last Name:BOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:222 W NEWTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2820
Practice Address - Country:US
Practice Address - Phone:724-834-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439185207Y00000X
DC153273207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102504690Medicaid
PA102504690Medicaid