Provider Demographics
NPI:1114933892
Name:NARDELLA, GUY M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:M
Last Name:NARDELLA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 W BALTIMORE PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-6105
Mailing Address - Country:US
Mailing Address - Phone:484-227-8350
Mailing Address - Fax:484-227-1645
Practice Address - Street 1:1118 W BALTIMORE PIKE STE 100
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:484-227-8350
Practice Address - Fax:484-227-1645
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016920E2083P0011X, 208200000X
DEC100066542082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079212HDHMedicare PIN
PAB35160Medicare UPIN
DE012008A01Medicare PIN