Provider Demographics
NPI:1508851874
Name:BARDIN, SIMEON L (MD)
Entity Type:Individual
Prefix:
First Name:SIMEON
Middle Name:L
Last Name:BARDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 FLOURTOWN AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7976
Mailing Address - Country:US
Mailing Address - Phone:215-233-1555
Mailing Address - Fax:215-233-0308
Practice Address - Street 1:8200 FLOURTOWN AVE
Practice Address - Street 2:STE 6
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7976
Practice Address - Country:US
Practice Address - Phone:215-233-1555
Practice Address - Fax:215-233-0308
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA052567L207R00000X
PAMD052567L207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007278000OtherTPI GROUP MA ID
PA110148353OtherRAILROAD MEDICARE
PA597586OtherTPI GROUP MEDICARE
PACD4829OtherTPI GROUP RAILROAD MEDICARE
PA0014616570001Medicaid
PA110148353OtherRAILROAD MEDICARE
B68203Medicare UPIN