Provider Demographics
NPI:1902543994
Name:BEDFORD MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:BEDFORD MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:310-409-2300
Mailing Address - Street 1:436 N BEDFORD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4323
Mailing Address - Country:US
Mailing Address - Phone:310-409-2300
Mailing Address - Fax:
Practice Address - Street 1:436 N BEDFORD DR STE 101
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4323
Practice Address - Country:US
Practice Address - Phone:310-409-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty