Provider Demographics
NPI:1235298662
Name:BADOLATO, JOSEPH P (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:BADOLATO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 E PASSYUNK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2128
Mailing Address - Country:US
Mailing Address - Phone:215-468-2553
Mailing Address - Fax:
Practice Address - Street 1:1818 E PASSYUNK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2128
Practice Address - Country:US
Practice Address - Phone:215-468-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04305300207Q00000X
PA0S005061L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0058472000OtherINDEPENDENCE BC
NJ6077609Medicaid
PA000124127OtherHIGHMARK BS
PA232251238 00001OtherCIGNA
PA4474097OtherAETNA
PAA24127OtherAMERIHEALTH ADMINISTRATORS
PA124127Medicare PIN
PA232251238 00001OtherCIGNA
PA4474097OtherAETNA