Provider Demographics
NPI:1083868905
Name:BEDNARSKI, BROOKE NICOLE BOSLEY (MD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE BOSLEY
Last Name:BEDNARSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:NICOLE
Other - Last Name:BOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:522 W NEWTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2890
Mailing Address - Country:US
Mailing Address - Phone:724-834-8113
Mailing Address - Fax:724-832-7496
Practice Address - Street 1:522 W NEWTON ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2890
Practice Address - Country:US
Practice Address - Phone:724-834-8113
Practice Address - Fax:724-832-7496
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439185207Y00000X
DC153273207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102504690Medicaid
PA102504690Medicaid