Provider Demographics
NPI:1407057375
Name:ROBERT E. BARDEN MD PA
Entity Type:Organization
Organization Name:ROBERT E. BARDEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EMMET
Authorized Official - Last Name:BARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-632-4800
Mailing Address - Street 1:1282 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2747
Mailing Address - Country:US
Mailing Address - Phone:321-632-4800
Mailing Address - Fax:321-632-6320
Practice Address - Street 1:1282 S US HIGHWAY 1
Practice Address - Street 2:SUITE 4
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2747
Practice Address - Country:US
Practice Address - Phone:321-632-4800
Practice Address - Fax:321-632-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLE59843207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3645Medicare ID - Type Unspecified