Healthcare Provider Details

I. General information

NPI: 1083697866
Provider Name (Legal Business Name): BETTY JEAN BARDELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 JACKSON ST
JAMESTOWN PA
16134-9186
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-932-2299
  • Fax: 724-932-2242
Mailing address:
  • Phone: 724-704-7386
  • Fax: 724-704-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD418701
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: