Provider Demographics
NPI:1235321639
Name:BRIAN D ARDEL MD PA
Entity type:Organization
Organization Name:BRIAN D ARDEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-627-3882
Mailing Address - Street 1:3417 TAMIAMI TRL STE D
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8158
Mailing Address - Country:US
Mailing Address - Phone:941-627-3882
Mailing Address - Fax:941-627-3290
Practice Address - Street 1:3417 TAMIAMI TRL STE D
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8158
Practice Address - Country:US
Practice Address - Phone:941-627-3882
Practice Address - Fax:941-627-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0050259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39340Medicare PIN