Healthcare Provider Details

I. General information

NPI: 1174978373
Provider Name (Legal Business Name): DR. JOSEPH BARDINELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH BARDINELLI D.O.

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 18
FPO AE
09645-0001
US

IV. Provider business mailing address

PSC 819 BOX 18
FPO AE
09645-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-860-6265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT016918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: