Provider Demographics
NPI:1508557422
Name:MCCARDELL, PATRICK R
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:MCCARDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MESSENGER ST APT 202
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-5039
Mailing Address - Country:US
Mailing Address - Phone:774-219-6912
Mailing Address - Fax:
Practice Address - Street 1:11 BOBCAT BLVD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NH
Practice Address - Zip Code:03244-7419
Practice Address - Country:US
Practice Address - Phone:603-478-5236
Practice Address - Fax:603-478-2049
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program