Basic Information
| Provider Information | |||||||||
| NPI: | 1598128316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARDET | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 KING OF PRUSSIA RD STE 2J | ||||||||
| Address2: | |||||||||
| City: | RADNOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190875235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109022450 | ||||||||
| FaxNumber: | 6109022466 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 KING OF PRUSSIA ROAD | ||||||||
| Address2: | SUITE 2 J | ||||||||
| City: | RADNOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190875220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109022450 | ||||||||
| FaxNumber: | 6109022466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2016 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
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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 | 207Q00000X | MD465430 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.