Basic Information
| Provider Information | |||||||||
| NPI: | 1760497390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDARELLI | ||||||||
| FirstName: | MARCELO | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37174 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714235699 | ||||||||
| FaxNumber: | 5714235698 | ||||||||
| Practice Location | |||||||||
| Address1: | 2921 TELESTAR CT | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220421205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032805858 | ||||||||
| FaxNumber: | 7038490874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D45046 | MD | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 0101258749 | VA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 112716 | 01 | MD | US HLTHCARE | OTHER | 418316 | 01 | MD | MDIPA | OTHER | 0015 | 01 | MD | CAREFIRST REGIONAL | OTHER | 1000034726 | 05 | DE | MEDICAID | 80005 | 01 | MD | GEISINGER | OTHER | 1752257 | 01 | MD | UNITED HLTHCARE NATIONAL | OTHER | 214328 | 01 | MD | KAISER | OTHER | 52858903 | 01 | MD | BLUE SHIELD | OTHER | 1800123 | 01 | MD | UNITED HLTHCARE | OTHER | 653881900 | 05 | MD | MEDICAID |