Provider Demographics
NPI:1205030160
Name:GEDEON, MAKRAM (MD)
Entity Type:Individual
Prefix:
First Name:MAKRAM
Middle Name:
Last Name:GEDEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PONDFIELD RD W STE 2
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2648
Mailing Address - Country:US
Mailing Address - Phone:914-787-4000
Mailing Address - Fax:212-342-0166
Practice Address - Street 1:1 PONDFIELD RD W STE 2
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2648
Practice Address - Country:US
Practice Address - Phone:914-787-4000
Practice Address - Fax:212-342-0166
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303208208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0019585OtherINSTITUTIONAL PERMIT
CT1205030160Medicaid
CT1205030160Medicaid