Provider Demographics
NPI:1659324135
Name:BEDETTI, CARLOS DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:DAVID
Last Name:BEDETTI
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 1:3530 MYSTIC POINTE DR APT 515
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4525
Mailing Address - Country:US
Mailing Address - Phone:412-858-2567
Mailing Address - Fax:954-739-7208
Practice Address - Street 1:3530 MYSTIC POINTE DR APT 515
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4525
Practice Address - Country:US
Practice Address - Phone:412-858-2567
Practice Address - Fax:954-739-7208
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036610L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA64979OtherMEDPLUS
PA0011423140001Medicaid
PA1514085OtherGATEWAY
PA250411OtherUPMC HEALTHPLAN
PA509493OtherHIGHMARK-PA BLUE SHIELD
PAP00641436OtherPALMETTO GBA RAILROAD MEDICARE
PA0011423140001Medicaid
509493Medicare ID - Type Unspecified