Provider Demographics
NPI:1528387875
Name:BEDARD, RACHAEL ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:BEDARD
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 1:128 S OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1604
Mailing Address - Country:US
Mailing Address - Phone:917-359-9473
Mailing Address - Fax:
Practice Address - Street 1:55 WATER ST FL 18
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10041-0004
Practice Address - Country:US
Practice Address - Phone:646-614-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244594390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program