Provider Demographics
NPI:1689759771
Name:BARDSLEY, MARTHA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:D
Last Name:BARDSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:DECHERT
Other - Last Name:ZEGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:822 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-601-3031
Mailing Address - Fax:
Practice Address - Street 1:822 MONTGOMERY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-601-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4260552080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408283400Medicaid
MD4082834Medicaid
PA101331486Medicaid
NJ0071315Medicaid
MD408283400Medicaid
PA101331486Medicaid