Provider Demographics
NPI:1184689804
Name:BADER, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:92 MONTVALE AVE
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3647
Mailing Address - Country:US
Mailing Address - Phone:781-438-5543
Mailing Address - Fax:781-438-2001
Practice Address - Street 1:92 MONTVALE AVE
Practice Address - Street 2:SUITE 3700
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3644
Practice Address - Country:US
Practice Address - Phone:781-438-5543
Practice Address - Fax:781-438-2001
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA52061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6175147Medicaid
MAB76334Medicare UPIN
MAJ02294Medicare PIN