MEDICARE: DR. GLENDA ANN CARDILLO M.D. MPH

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	2083P0901X	Public Health & General Preventive Medicine Physician	MD432127	PA

General Provider Information

NPI Number	:	1659519858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENDA ANN CARDILLO M.D. MPH

Provider Business Mailing Address
First Line	:	1514 N 2ND ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17102-2505
Country	:	US
Telephone Number	:	717-234-2468
Fax Number	:	717-901-5351

Provider Business Practice Location Address
First Line	:	1514 N 2ND ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17102-2505
Country	:	US
Telephone Number	:	717-234-2468
Fax Number	:	717-901-5351

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

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	01/26/2009

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