Provider Demographics
NPI:1326117300
Name:BARDMAN, NELLY (MD)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:BARDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15710 NE 24TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2444
Mailing Address - Country:US
Mailing Address - Phone:425-208-0026
Mailing Address - Fax:425-644-3868
Practice Address - Street 1:15710 NE 24TH ST STE C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2444
Practice Address - Country:US
Practice Address - Phone:425-208-0026
Practice Address - Fax:425-644-3868
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00044878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine