MEDICARE: RONALD DOMINIC NARDELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	10518	NV
2	207Q00000X	Family Medicine Physician	MD421023	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467434688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD DOMINIC NARDELL MD

Provider Business Mailing Address
First Line	:	610 WYOMING AVE
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-3702
Country	:	US
Telephone Number	:	570-288-5441
Fax Number	:	570-288-5842

Provider Business Practice Location Address
First Line	:	16 LUZERNE AVE
Second Line	:	SUITE 125
City	:	WEST PITTSTON
State	:	PA
Zip	:	18643-2817
Country	:	US
Telephone Number	:	570-654-6714
Fax Number	:	570-654-9599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/22/2014

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