Provider Demographics
NPI:1023151180
Name:BEDELL, SUSANNA (MD)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:BEDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CYPRESS ST
Mailing Address - Street 2:BRIGHAM AND WOMENS PHYSICIANS ORGANIZATION
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-582-1200
Mailing Address - Fax:
Practice Address - Street 1:850 BOYLSTON ST SUITE 530
Practice Address - Street 2:BRIGHAM AND WOMENS HOSPITAL PHYSICIAN GROUP
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2015-09-22
Deactivation Date:2012-01-26
Deactivation Code:
Reactivation Date:2015-09-22
Provider Licenses
StateLicense IDTaxonomies
MA43059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine