Provider Demographics
NPI:1407873227
Name:BADOLATO, JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
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 1:605 5TH AVE S STE 150
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3887
Mailing Address - Country:US
Mailing Address - Phone:206-462-4859
Mailing Address - Fax:
Practice Address - Street 1:605 5TH AVE S STE 150
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3887
Practice Address - Country:US
Practice Address - Phone:206-462-4859
Practice Address - Fax:206-223-7926
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8198293Medicaid
G34652Medicare UPIN
WAG8898728Medicare PIN
WA8198293Medicaid