Provider Demographics
NPI:1194719658
Name:BEDINE, MARSHALL STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:STEPHEN
Last Name:BEDINE
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 1:10751 FALLS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4517
Mailing Address - Country:US
Mailing Address - Phone:410-583-2633
Mailing Address - Fax:
Practice Address - Street 1:10751 FALLS RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4517
Practice Address - Country:US
Practice Address - Phone:410-583-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD7926174400000X
MDD07926207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD169947ZFHQMedicare PIN
MDB67779Medicare UPIN