Provider Demographics
NPI:1306328851
Name:NELSON V. BERARDINELLI
Entity type:Organization
Organization Name:NELSON V. BERARDINELLI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:V
Authorized Official - Last Name:BERARDINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-733-2122
Mailing Address - Street 1:4154 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1942
Mailing Address - Country:US
Mailing Address - Phone:724-733-2122
Mailing Address - Fax:
Practice Address - Street 1:4154 OLD WILLIAM PEN HIGHWAY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668
Practice Address - Country:US
Practice Address - Phone:724-733-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADL021833L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1548377278OtherDME