Provider Demographics
NPI:1235180159
Name:CARDALI, PAUL B (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:CARDALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 W MORRIS BLVD
Mailing Address - Street 2:SUITE 400C HEALTHSTAR PHYSICIANS
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2283
Mailing Address - Country:US
Mailing Address - Phone:423-586-0443
Mailing Address - Fax:423-586-0431
Practice Address - Street 1:420 W MORRIS BLVD
Practice Address - Street 2:HEALTHSTAR PHYSICIANS
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-586-0443
Practice Address - Fax:423-586-0431
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD33834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3849990Medicaid
TN3849990Medicaid
TN3849990Medicare PIN