Provider Demographics
NPI:1811133598
Name:CARDAMONE, S. JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:S. JOSEPH
Middle Name:
Last Name:CARDAMONE
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 1:860 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3229
Mailing Address - Country:US
Mailing Address - Phone:610-525-7215
Mailing Address - Fax:610-525-7215
Practice Address - Street 1:860 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3229
Practice Address - Country:US
Practice Address - Phone:610-525-7215
Practice Address - Fax:610-525-7215
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027630L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7047063Medicaid