Provider Demographics
NPI:1134297716
Name:MARDELLI, TALAAT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:TALAAT
Middle Name:JOSEPH
Last Name:MARDELLI
Suffix:
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 1:11 WYNDAM COURT
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3715
Mailing Address - Country:US
Mailing Address - Phone:443-275-1676
Mailing Address - Fax:443-275-1676
Practice Address - Street 1:3001 SOUTH HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1290
Practice Address - Country:US
Practice Address - Phone:410-350-3200
Practice Address - Fax:410-350-2010
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023521207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B67113Medicare UPIN
5682Medicare PIN