Healthcare Provider Details

I. General information

NPI: 1831121946
Provider Name (Legal Business Name): ROBERT CARLO NARDONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 WORCESTER ST SUITE 301
WELLESLEY HILLS MA
02481-5341
US

IV. Provider business mailing address

422 WORCESTER ST SUITE 301
WELLESLEY HILLS MA
02481-5341
US

V. Phone/Fax

Practice location:
  • Phone: 781-235-8366
  • Fax: 781-235-5929
Mailing address:
  • Phone: 781-235-8366
  • Fax: 781-235-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number47235
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47235
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: