Provider Demographics
NPI:1083697866
Name:BARDELLA, BETTY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:BARDELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-704-7386
Mailing Address - Fax:724-704-7390
Practice Address - Street 1:402 JACKSON ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:PA
Practice Address - Zip Code:16134-9186
Practice Address - Country:US
Practice Address - Phone:724-932-2299
Practice Address - Fax:724-932-2242
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018833510003Medicaid
PA0018833510003Medicaid
PAE30264Medicare UPIN