Provider Demographics
NPI:1477628675
Name:BLEDSOE, KAREN LETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LETTA
Last Name:BLEDSOE
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 1:7404 EXECUTIVE PL STE 501
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6238
Mailing Address - Country:US
Mailing Address - Phone:301-262-0260
Mailing Address - Fax:
Practice Address - Street 1:7404 EXECUTIVE PLACE
Practice Address - Street 2:#501
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-262-0260
Practice Address - Fax:301-262-0630
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29687Medicare UPIN
006519E60Medicare ID - Type Unspecified