Provider Demographics
NPI:1457664880
Name:BADAL, MADAN KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:MADAN
Middle Name:KUMAR
Last Name:BADAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-660-5220
Mailing Address - Fax:336-660-5229
Practice Address - Street 1:3515 W MARKET ST STE 110
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4439
Practice Address - Country:US
Practice Address - Phone:336-660-5220
Practice Address - Fax:336-660-5229
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448878207R00000X, 207RC0000X
NC202103075207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102830758Medicaid
PA289314Medicare PIN