Provider Demographics
NPI:1619978889
Name:BARDALES, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:BARDALES
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 1:618 PLEASANTVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3312
Mailing Address - Country:US
Mailing Address - Phone:740-653-7511
Mailing Address - Fax:740-689-9236
Practice Address - Street 1:618 PLEASANTVILLE RD
Practice Address - Street 2:STE 101
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3312
Practice Address - Country:US
Practice Address - Phone:740-653-7511
Practice Address - Fax:740-653-7512
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074693207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2087898Medicaid
OHG93092Medicare UPIN
OH2087898Medicaid