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General NPI Number Information
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NPI Number | 1083697866
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Entity Type | Individual
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Provider Name | BETTY JEAN BARDELLA MD
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Gender | Female
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 402 JACKSON ST
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City | JAMESTOWN
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State | PA
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Zip | 16134-9186
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Country | US
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Telephone | 724-932-2299
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Fax | 724-932-2242
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Provider Business Mailing Address
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Address Line | 100 SHENANGO AVE
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City | SHARON
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State | PA
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Zip | 16146-1503
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Country | US
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Telephone | 724-704-7386
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Fax | 724-704-7390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD418701
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License Number State | PA
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