Basic Information
| Provider Information | |||||||||
| NPI: | 1477519809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDELLO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2340 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUSHING | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740232905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182256904 | ||||||||
| FaxNumber: | 9182254559 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUSHING | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740232905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182256904 | ||||||||
| FaxNumber: | 9182254559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 09/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA623 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.