Provider Demographics
NPI:1205034469
Name:BADERELDIN, MAGDY SAMI (MD AND PA)
Entity Type:Individual
Prefix:DR
First Name:MAGDY
Middle Name:SAMI
Last Name:BADERELDIN
Suffix:
Gender:M
Credentials:MD AND PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 WORCESTER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1001
Mailing Address - Country:US
Mailing Address - Phone:413-543-6820
Mailing Address - Fax:
Practice Address - Street 1:59 TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1318
Practice Address - Country:US
Practice Address - Phone:617-442-8760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3743363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical