Provider Demographics
NPI:1588843866
Name:WOLDAREGAY, BEDILU W (MD)
Entity Type:Individual
Prefix:DR
First Name:BEDILU
Middle Name:W
Last Name:WOLDAREGAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-272-8173
Mailing Address - Fax:717-272-4029
Practice Address - Street 1:850 TUCK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:171-272-8173
Practice Address - Fax:717-272-4029
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464573207RP1001X
CT045925207R00000X
OK32625207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588843866Medicaid
MO645046OtherCOVENTRY HEALTHCARE
MO46589035OtherBCBS OF KS
MO681522OtherCOVENTRY HEALTHCARE
MT133114OtherHEALTHCARE USA
MO46589025OtherBCBS OF KC