Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD016920E | PA |
Y | 208600000X | Surgeon | MD016920E | PA |
N | 2082S0105X | Plastic Hand Surgeon | C10006654 | DE |
NPI | 1114933892 |
---|---|
Provider Name | Dr. Guy M Nardella JR. |
First Address | Media, PA 19063-6105 |
Second Address | Media, PA 19063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 05/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B35160 | (02) | PA |