Provider Demographics
NPI:1720045677
Name:ARDINGER, ROBERT HALL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HALL
Last Name:ARDINGER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12404 KALLGREN RD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3328
Mailing Address - Country:US
Mailing Address - Phone:913-626-0662
Mailing Address - Fax:913-626-0662
Practice Address - Street 1:12404 KALLGREN RD NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3328
Practice Address - Country:US
Practice Address - Phone:913-626-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA606360022080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207987918Medicaid
KS100120930BMedicaid