Provider Demographics
NPI:1235828526
Name:BEDICCAA MEDICAL SERVICES
Entity Type:Organization
Organization Name:BEDICCAA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:N
Authorized Official - Last Name:ARAH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:240-481-8126
Mailing Address - Street 1:4850 FORBES BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4882
Mailing Address - Country:US
Mailing Address - Phone:301-459-5667
Mailing Address - Fax:301-459-7059
Practice Address - Street 1:4850 FORBES BLVD STE D
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4882
Practice Address - Country:US
Practice Address - Phone:301-459-5667
Practice Address - Fax:301-459-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty