Provider Demographics
NPI:1134136732
Name:B.L. CARDEN, MD,LLC
Entity Type:Organization
Organization Name:B.L. CARDEN, MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:CARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-664-0210
Mailing Address - Street 1:1810 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-3177
Mailing Address - Country:US
Mailing Address - Phone:334-448-1899
Mailing Address - Fax:
Practice Address - Street 1:1810 STADIUM DR
Practice Address - Street 2:SUITE 220
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3100
Practice Address - Country:US
Practice Address - Phone:334-664-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDA7204OtherRAILROAD MEDICARE
ALP00069193OtherRAILROAD PIN
AL529917770Medicaid
GAGRP6126Medicare PIN
AL051517378Medicare PIN
ALE01148Medicare UPIN
ALP00069193OtherRAILROAD PIN
GA08BBQLVMedicare PIN