1194794701 NPI number — ROBERTO CARDARELLI DO

Table of content: ROBERTO CARDARELLI DO (NPI 1194794701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194794701 NPI number — ROBERTO CARDARELLI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDARELLI
Provider First Name:
ROBERTO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194794701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2195 HARRODSBURG RD
Provider Second Line Business Mailing Address:
SUITE 125
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40504-3504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-257-8562
Provider Business Mailing Address Fax Number:
859-323-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2195 HARRODSBURG RD
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-257-8562
Provider Business Practice Location Address Fax Number:
859-323-6661
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  03612 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: L8295 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: TP366 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8P5410 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 166541601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00139489 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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