Healthcare Provider Details

I. General information

NPI: 1124001284
Provider Name (Legal Business Name): JOHN R MCARDLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 923
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

2110 SILAS DEANE HWY
ROCKY HILL CT
06067-2313
US

V. Phone/Fax

Practice location:
  • Phone: 860-547-1876
  • Fax: 860-520-1379
Mailing address:
  • Phone: 860-258-3470
  • Fax: 860-571-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number035792
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number035792
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: