Basic Information
| Provider Information | |||||||||
| NPI: | 1285735373 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONICA K BEDI MD PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | DERMATOLOGY ASSOCIATES OF SARASOTA, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850001 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328850147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419275178 | ||||||||
| FaxNumber: | 9419216838 | ||||||||
| Practice Location | |||||||||
| Address1: | 3830 BEE RIDGE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342331105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419275178 | ||||||||
| FaxNumber: | 9419216838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BEDI | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9419275178 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME79670 | FL | N | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 7670411 | 01 | FL | AETNA | OTHER | P00256517 | 01 | FL | RR MEDICARE M BEDI | OTHER | 2201112 | 01 | FL | GHI GROUP | OTHER | DD8628 | 01 | FL | RR MEDICARE GROUP | OTHER |