DR. DMITRY BEDERAK DNP CRNP NPI 1194490250

NPI Information

NPI: 1194490250
Provider Name: DR. DMITRY BEDERAK, DNP, CRNP
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
6701 N CHARLES ST STE 4105
BALTIMORE, MD
ZIP 21204
Phone: (443) 849-8200
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DR. Dmitry Bederak, DNP, CRNP is a gerontology nurse practitioner in Baltimore, MD with 3 years of experience. DR. Dmitry Bederak, DNP, CRNP NPI is 1194490250. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6701 N CHARLES ST STE 4105
BALTIMORE, MD
ZIP 21204-881
Phone: (443) 849-8200

The NPI 1194490250 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/11/2021 and was last updated on 7/23/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	R204060	MARYLAND	No
2	363LP2300X	Nurse Practitioner	Primary Care	R204060	MARYLAND	No
3	363LG0600X	Nurse Practitioner	Gerontology	R204060	MARYLAND	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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