Provider Demographics
NPI:1386665073
Name:JOSEPH M. BEDNAREK MDPC
Entity Type:Organization
Organization Name:JOSEPH M. BEDNAREK MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEDNAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-739-2121
Mailing Address - Street 1:2407 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4402
Mailing Address - Country:US
Mailing Address - Phone:215-739-2121
Mailing Address - Fax:215-739-5231
Practice Address - Street 1:501 BATH RD
Practice Address - Street 2:SUITE 208
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3101
Practice Address - Country:US
Practice Address - Phone:215-781-9300
Practice Address - Fax:215-781-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013626E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006109770001Medicaid
PA0000104155Medicare ID - Type Unspecified
PA0006109770001Medicaid