Provider Demographics
NPI: | 1922354380 |
---|---|
Name: | BEDELL, ELIZABETH ANNE (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | ELIZABETH |
Middle Name: | ANNE |
Last Name: | BEDELL |
Suffix: | |
Gender: | F |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | ELIZABETH |
Other - Middle Name: | ANNE |
Other - Last Name: | VILLEGAS |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 3421 CONCORD RD |
Mailing Address - Street 2: | |
Mailing Address - City: | YORK |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17402-9001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-812-5229 |
Mailing Address - Fax: | 717-266-7453 |
Practice Address - Street 1: | 235 ROSEDALE DR |
Practice Address - Street 2: | |
Practice Address - City: | MANCHESTER |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17345-1022 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-812-5229 |
Practice Address - Fax: | 717-266-7453 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-08-02 |
Last Update Date: | 2016-09-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 125109 | 207Q00000X |
PA | OS017490 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | P01695794 | Other | RAILROAD MEDICARE |
PA | 103059247 | Medicaid | |
PA | PO1695797 | Other | RAILROAD MEDICARE |
PA | P01695794 | Other | RAILROAD MEDICARE |