Provider Demographics
NPI:1972597565
Name:BARDEN THORWARTH DAUGHTRIDGE LTD
Entity type:Organization
Organization Name:BARDEN THORWARTH DAUGHTRIDGE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMPLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-220-9074
Mailing Address - Street 1:PO BOX 11268
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17605-1268
Mailing Address - Country:US
Mailing Address - Phone:585-472-4436
Mailing Address - Fax:614-210-1874
Practice Address - Street 1:8835 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2718
Practice Address - Country:US
Practice Address - Phone:215-248-8200
Practice Address - Fax:215-248-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056209EQXMedicare PIN
PA=========Medicare PIN