Provider Demographics
NPI:1922007681
Name:NARDIN, DAVID WEBSTER (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WEBSTER
Last Name:NARDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PADDOCK CT
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1370
Mailing Address - Country:US
Mailing Address - Phone:740-363-1975
Mailing Address - Fax:740-363-4662
Practice Address - Street 1:241 PADDOCK CT
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1370
Practice Address - Country:US
Practice Address - Phone:740-363-1975
Practice Address - Fax:740-363-4662
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-02-8286N207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000117971OtherANTHEM
OH0082379Medicaid
OH000000117971OtherANTHEM
OHDA0139081Medicare ID - Type Unspecified