Provider Demographics
NPI:1477519809
Name:CARDELLO, JOSEPH A (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:CARDELLO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-2905
Mailing Address - Country:US
Mailing Address - Phone:918-225-6904
Mailing Address - Fax:918-225-4559
Practice Address - Street 1:2340 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2905
Practice Address - Country:US
Practice Address - Phone:918-225-6904
Practice Address - Fax:918-225-4559
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA623363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP88947Medicare UPIN
OK244422201Medicare ID - Type Unspecified