Provider Demographics
NPI:1831197201
Name:BEDICHEK, ELLEN G (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:G
Last Name:BEDICHEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:671 HIOAKS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:804-272-5814
Mailing Address - Fax:804-560-0232
Practice Address - Street 1:8485 BELL CREEK RD
Practice Address - Street 2:UNIT B2
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3866
Practice Address - Country:US
Practice Address - Phone:804-559-9757
Practice Address - Fax:804-559-9341
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2016-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101041981207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5821142Medicaid
VAD98352Medicare UPIN
VA5821142Medicaid