Provider Demographics
NPI:1205147139
Name:BEDNARZ, PRZEMYSLAW JERZY (MD)
Entity type:Individual
Prefix:
First Name:PRZEMYSLAW
Middle Name:JERZY
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 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3517
Mailing Address - Fax:
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 301
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457067207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103127042Medicaid
PA511844Medicare PIN