Provider Demographics
NPI:1912991423
Name:SARDELLA, GERALD L (MD FACS)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:SARDELLA
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 SMOKEY RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4311
Mailing Address - Country:US
Mailing Address - Phone:603-224-1725
Mailing Address - Fax:603-224-6094
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-1725
Practice Address - Fax:603-224-6094
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY203222208G00000X
NH13758208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
G28967Medicare UPIN