Provider Demographics
NPI:1154521771
Name:BERDECIO, EDUARDO T (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:T
Last Name:BERDECIO
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 1:620 COURT ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-1312
Mailing Address - Country:US
Mailing Address - Phone:434-455-2082
Mailing Address - Fax:
Practice Address - Street 1:620 COURT ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-1312
Practice Address - Country:US
Practice Address - Phone:434-455-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242163103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT123469Medicare UPIN