Provider Demographics
NPI:1881687341
Name:BEDNARZ, LUCIAN P (MD)
Entity Type:Individual
Prefix:
First Name:LUCIAN
Middle Name:P
Last Name:BEDNARZ
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 1:5 MORGAN HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-344-3788
Mailing Address - Fax:570-969-9280
Practice Address - Street 1:5 MORGAN HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-344-3788
Practice Address - Fax:570-969-9280
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054459L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA545626OtherBLUE CARE
PA2252156OtherAETNA
PA001598910-0004Medicaid
PA20038442OtherAMERIHEALTH
PA50075037OtherCAPITAL BLUE CROSS
PA140004801OtherRAILROAD MEDICARE
PA22387-1067OtherGEISINGER
PA804214OtherBLUE CARE HMO (FPH)
PA20038442OtherAMERIHEALTH
PAF92138Medicare UPIN