Provider Demographics
NPI:1124043310
Name:BADGER, MICHAEL CHANNING (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHANNING
Last Name:BADGER
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-643-5800
Mailing Address - Fax:336-643-7474
Practice Address - Street 1:6161 LAKE BRANDT RD UNIT B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-8415
Practice Address - Country:US
Practice Address - Phone:336-643-5800
Practice Address - Fax:336-643-7474
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009901103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129PGMedicaid
SCQ0110MMedicaid
NC0173AOtherBCBSNC
2004961Medicare ID - Type Unspecified
NC2004961FMedicare PIN
NC89129PGMedicaid
NC2004961DMedicare PIN