Provider Demographics
NPI:1871547729
Name:BARDOFF, CELIA IRIS (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CELIA
Middle Name:IRIS
Last Name:BARDOFF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 W NORTHERN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1431
Mailing Address - Country:US
Mailing Address - Phone:410-433-0801
Mailing Address - Fax:
Practice Address - Street 1:1190 W NORTHERN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1431
Practice Address - Country:US
Practice Address - Phone:410-433-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR085704363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics