Provider Demographics
NPI:1902890270
Name:FARDO, BARBARA ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ELLEN
Last Name:FARDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 EXECUTIVE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6442
Mailing Address - Country:US
Mailing Address - Phone:724-741-0044
Mailing Address - Fax:724-741-0040
Practice Address - Street 1:213 EXECUTIVE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6442
Practice Address - Country:US
Practice Address - Phone:724-741-0044
Practice Address - Fax:724-741-0040
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008781L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1666500Medicaid
PA080169544OtherMEDICARE RAILROAD
PA907760J8WMedicare PIN
PA080169544OtherMEDICARE RAILROAD
PA1666500Medicaid