Provider Demographics
NPI:1871657650
Name:BEDAR, BRADFORD (EDD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:
Last Name:BEDAR
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 GREAT PLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1719
Mailing Address - Country:US
Mailing Address - Phone:781-449-0087
Mailing Address - Fax:781-449-8684
Practice Address - Street 1:1253 GREAT PLAIN AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-1719
Practice Address - Country:US
Practice Address - Phone:781-449-0087
Practice Address - Fax:781-449-8684
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2779103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003279OtherHARVARD PILGRIM
MABEW02836Medicare ID - Type Unspecified