Provider Demographics
NPI:1801295803
Name:BARDOFF, INNA (CRNP)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:BARDOFF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:INNA
Other - Middle Name:
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 62887
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2887
Mailing Address - Country:US
Mailing Address - Phone:410-602-7782
Mailing Address - Fax:410-602-2438
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-602-7782
Practice Address - Fax:410-602-2438
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR176299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner