Basic Information
| Provider Information | |||||||||
| NPI: | 1851392096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEDARD-RYAN | ||||||||
| FirstName: | MADELEINE | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035702006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037523669 | ||||||||
| FaxNumber: | 6037523027 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | GORHAM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035811502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034662741 | ||||||||
| FaxNumber: | 6034662953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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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 | 213E00000X | 210 | NH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 210 | 01 | NH | STATE LICENSE # | OTHER | 0308284Y0NH02 | 01 | NH | ANTHEM BC/BS | OTHER | 3072617 | 05 | NH | MEDICAID | 5830418 | 01 | AETNA GROUP | OTHER | P00100691 | 01 | RAILROAD MEDICARE | OTHER | 3883468001 | 01 | NH | CIGNA HEALTHCARE | OTHER |