Basic Information
| Provider Information | |||||||||
| NPI: | 1568418572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEDNAREK | ||||||||
| FirstName: | PAVLA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 4330 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142556900 | ||||||||
| FaxNumber: | 6142556901 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 4330 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142556900 | ||||||||
| FaxNumber: | 6142556901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35083931 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 35-083931 | OH | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2492360 | 05 | OH | MEDICAID |