Provider Demographics
NPI:1114020682
Name:BARADARAN, ASADOLAH (MD)
Entity Type:Individual
Prefix:
First Name:ASADOLAH
Middle Name:
Last Name:BARADARAN
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 1:726 EAST MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-342-1495
Mailing Address - Fax:845-342-1367
Practice Address - Street 1:726 EAST MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-342-1495
Practice Address - Fax:845-342-1367
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1924012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
23002OtherGHI PPO
OR0000414OtherSELECT PRO
NY01417216Medicaid
13539OtherWELLCARE
3584056003OtherCIGNA
62270OtherPRUDENTIAL
ABA726109OtherFINGERLAKES BCBS
137122OtherMVP
YS041OtherOXFORD
69H741OtherEMPIRE BCBS
O46O793OtherAETNA US HEALTHCARE
NY01417216Medicaid
F57613Medicare UPIN