Provider Demographics
NPI:1225131824
Name:BADULAK, ANDREW A (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:A
Last Name:BADULAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S HENDERSON RD
Mailing Address - Street 2:STE 308C
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406
Mailing Address - Country:US
Mailing Address - Phone:610-337-3111
Mailing Address - Fax:610-337-3506
Practice Address - Street 1:700 S HENDERSON RD
Practice Address - Street 2:STE 308C
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:610-337-3111
Practice Address - Fax:610-337-3506
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA05006960E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA588258OtherBCBS
E23852Medicare UPIN
PA588258OtherBCBS