Provider Demographics
NPI:1194794701
Name:CARDARELLI, ROBERTO (DO)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:CARDARELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 HARRODSBURG RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3504
Mailing Address - Country:US
Mailing Address - Phone:859-257-8562
Mailing Address - Fax:859-323-6661
Practice Address - Street 1:2195 HARRODSBURG RD
Practice Address - Street 2:SUITE 125
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3504
Practice Address - Country:US
Practice Address - Phone:859-257-8562
Practice Address - Fax:859-323-6661
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03612207Q00000X
TXL8295207Q00000X
KYTP366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P5410OtherBCBS
TX166541601Medicaid
TXP00139489OtherRAILROAD MEDICARE PIN
TX8P5410OtherBCBS
TXP00139489OtherRAILROAD MEDICARE PIN