Provider Demographics
NPI:1497954200
Name:BADWAN, WAFA RAWHI
Entity Type:Individual
Prefix:DR
First Name:WAFA
Middle Name:RAWHI
Last Name:BADWAN
Suffix:
Gender:F
Credentials:
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 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2355 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2847
Practice Address - Country:US
Practice Address - Phone:252-744-2545
Practice Address - Fax:252-744-1817
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25554207R00000X, 207RN0300X
NC2008-01262207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1501EOtherBCBSNC
NC1497954200Medicaid
NC1501EOtherBCBSNC