Provider Demographics
NPI:1831121946
Name:NARDONE, ROBERT CARLO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARLO
Last Name:NARDONE
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 1:422 WORCESTER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5341
Mailing Address - Country:US
Mailing Address - Phone:781-235-8366
Mailing Address - Fax:781-235-5929
Practice Address - Street 1:422 WORCESTER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-5341
Practice Address - Country:US
Practice Address - Phone:781-235-8366
Practice Address - Fax:781-235-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA472352084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA047235OtherTUFTS HEALTH PLAN
MAJ02590OtherBLUECROSSBLUESHIELD
MAA56764Medicare UPIN
MAJ02590Medicare ID - Type Unspecified