Provider Demographics
NPI:1700860657
Name:BEDWELL, SCOTT H (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:H
Last Name:BEDWELL
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 1:15 S MAIN ST STE 170
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6627
Mailing Address - Country:US
Mailing Address - Phone:716-483-1183
Mailing Address - Fax:716-483-2445
Practice Address - Street 1:15 S MAIN ST STE 170
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6627
Practice Address - Country:US
Practice Address - Phone:716-483-1183
Practice Address - Fax:716-483-2445
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027695E208600000X
NY156627-01208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E12962Medicare UPIN