Provider Demographics
NPI:1043323686
Name:BERARDELLI, JOSEPH F (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:BERARDELLI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ADAMS AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2025
Mailing Address - Country:US
Mailing Address - Phone:570-342-0030
Mailing Address - Fax:570-342-1729
Practice Address - Street 1:401 ADAMS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2025
Practice Address - Country:US
Practice Address - Phone:570-342-0030
Practice Address - Fax:570-342-1729
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051521363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091088Medicare ID - Type Unspecified