Provider Demographics
NPI:1780668442
Name:BEDROSIAN, EMOGENE H (MD)
Entity Type:Individual
Prefix:DR
First Name:EMOGENE
Middle Name:H
Last Name:BEDROSIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:LEE
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:98 STOESSEL AVE
Mailing Address - City:CHAUTAUQUA
Mailing Address - State:NY
Mailing Address - Zip Code:14722-0451
Mailing Address - Country:US
Mailing Address - Phone:716-753-2061
Mailing Address - Fax:716-753-2062
Practice Address - Street 1:98 STOESSEL AVE.
Practice Address - Street 2:
Practice Address - City:CHAUTAUQUA
Practice Address - State:NY
Practice Address - Zip Code:14722-0451
Practice Address - Country:US
Practice Address - Phone:716-753-2061
Practice Address - Fax:716-753-2062
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149180207P00000X
OH89323207P00000X
PAMD 021439 E207P00000X
NJ25MA07033400207P00000X
VA0101222151207P00000X
FLME81145207P00000X
MDD0022869207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHN409522OtherWELLCARE
OH000000381808OtherANTHEM
OH2781664Medicaid
OH000000162489OtherANTHEM
OH000000268968OtherANTHEM
OHBE4217494Medicare PIN
OHBE4217491Medicare PIN
OHBE4217492Medicare PIN
E28204Medicare UPIN