Provider Demographics
NPI:1568686376
Name:BEDFORD INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:BEDFORD INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DUPUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-645-6652
Mailing Address - Street 1:40 S RIVER RD UNIT 16
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6721
Mailing Address - Country:US
Mailing Address - Phone:603-645-6652
Mailing Address - Fax:603-624-1634
Practice Address - Street 1:40 SOUTH RIVER RD
Practice Address - Street 2:BEDFORD PLACE UNIT 16
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6721
Practice Address - Country:US
Practice Address - Phone:603-645-6652
Practice Address - Fax:603-624-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80002202Medicaid