Basic Information
| Provider Information | |||||||||
| NPI: | 1801295803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARDOFF | ||||||||
| FirstName: | INNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RUBIN | ||||||||
| OtherFirstName: | INNA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | CRNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 62887 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212642887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106027782 | ||||||||
| FaxNumber: | 4106022438 | ||||||||
| Practice Location | |||||||||
| Address1: | 1838 GREENE TREE RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212086391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106027782 | ||||||||
| FaxNumber: | 4106022438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2014 | ||||||||
| LastUpdateDate: | 10/14/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R176299 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.