Provider Demographics
NPI:1487602421
Name:BEDON, GEORGE A (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:BEDON
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 1:515 FAIRMOUNT AVE
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-494-1324
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1244
Practice Address - Fax:410-494-1386
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD12732207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD026261701Medicaid
MD1645Medicare PIN
MD157676Medicare PIN
MD026261701Medicaid
MD290005687Medicare PIN
MD158208ZD2XMedicare PIN