MEDICARE: GERALD L SARDELLA MD FACS

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	203222	NY
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	13758	NH

General Provider Information

NPI Number	:	1912991423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD L SARDELLA MD FACS

Provider Business Mailing Address
First Line	:	1 SMOKEY RD
Second Line	:
City	:	BOW
State	:	NH
Zip	:	03304-4311
Country	:	US
Telephone Number	:	603-224-1725
Fax Number	:	603-224-6094

Provider Business Practice Location Address
First Line	:	246 PLEASANT ST
Second Line	:	SUITE 103
City	:	CONCORD
State	:	NH
Zip	:	03301-2548
Country	:	US
Telephone Number	:	603-224-1725
Fax Number	:	603-224-6094

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	12/09/2009

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