Provider Demographics
NPI:1457685653
Name:BEDARIDA, GABRIELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:
Last Name:BEDARIDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2012
Mailing Address - Country:US
Mailing Address - Phone:203-215-6988
Mailing Address - Fax:203-401-0335
Practice Address - Street 1:1 HOWE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5473
Practice Address - Country:US
Practice Address - Phone:203-215-6988
Practice Address - Fax:203-401-0335
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine