Provider Demographics
NPI:1548209125
Name:BEDFORD, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BEDFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4980
Mailing Address - Country:US
Mailing Address - Phone:203-375-1200
Mailing Address - Fax:203-378-2412
Practice Address - Street 1:2890 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4980
Practice Address - Country:US
Practice Address - Phone:203-375-1200
Practice Address - Fax:203-378-2412
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036902207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001369025Medicaid
CT001369025Medicaid
CT100000329Medicare ID - Type UnspecifiedAB'S MEDICARE NUMBER