Provider Demographics
NPI:1851392096
Name:BEDARD-RYAN, MADELEINE (DPM)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:BEDARD-RYAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2006
Mailing Address - Country:US
Mailing Address - Phone:603-752-3669
Mailing Address - Fax:603-752-3027
Practice Address - Street 1:2 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1502
Practice Address - Country:US
Practice Address - Phone:603-466-2741
Practice Address - Fax:603-466-2953
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH210213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH210OtherSTATE LICENSE #
NH0308284Y0NH02OtherANTHEM BC/BS
NH3072617Medicaid
5830418OtherAETNA GROUP
P00100691OtherRAILROAD MEDICARE
NH3883468001OtherCIGNA HEALTHCARE
NH0308284Y0NH02OtherANTHEM BC/BS
RE0119Medicare ID - Type Unspecified