Provider Demographics
NPI:1407848906
Name:BADALIAN, SAMUEL S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:BADALIAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-3160
Mailing Address - Fax:607-547-6303
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-3160
Practice Address - Fax:607-547-6303
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211964207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01923284Medicaid
NY01869130Medicaid
NYBB5161Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL FULTO
NY01923284Medicaid
NYG94190Medicare UPIN