Provider Demographics
NPI:1164407193
Name:BARDO, DALE D (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:D
Last Name:BARDO
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:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-0101
Mailing Address - Country:US
Mailing Address - Phone:207-645-4577
Mailing Address - Fax:
Practice Address - Street 1:4 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-4838
Practice Address - Country:US
Practice Address - Phone:207-645-4577
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6916208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED03633Medicare UPIN
ME006238Medicare ID - Type Unspecified