MEDICARE: DR. NICHOLAS M. CARDINALE M.D..

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	039542	GA

General Provider Information

NPI Number	:	1922073212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS M. CARDINALE M.D..

Provider Business Mailing Address
First Line	:	2841 RENDOVA RD
Second Line	:	COMNAVSURFOR MEDICAL DEPT (CODE N01MA)
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5490
Country	:	US
Telephone Number	:	619-437-2860
Fax Number	:	619-437-2700

Provider Business Practice Location Address
First Line	:	2841 RENDOVA RD
Second Line	:	COMNAVSURFOR MEDICAL DEPT (CODE N01MA)
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5490
Country	:	US
Telephone Number	:	619-437-2860
Fax Number	:	619-437-2700

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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