Provider Demographics
NPI:1487827408
Name:BANDOLA, DAVID MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:BANDOLA
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 1:601 HAMBURG TPKE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2048
Mailing Address - Country:US
Mailing Address - Phone:862-248-0668
Mailing Address - Fax:862-248-0669
Practice Address - Street 1:601 HAMBURG TPKE
Practice Address - Street 2:SUITE 204
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2048
Practice Address - Country:US
Practice Address - Phone:862-248-0668
Practice Address - Fax:862-248-0669
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08735700207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology