Provider Demographics
NPI:1528254570
Name:BEDELL, JOHN DOUGLAS III (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:BEDELL
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4042A AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558
Mailing Address - Country:US
Mailing Address - Phone:516-670-8800
Mailing Address - Fax:
Practice Address - Street 1:4042 AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1226
Practice Address - Country:US
Practice Address - Phone:516-670-8800
Practice Address - Fax:516-670-8803
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine