Provider Demographics
NPI:1578787941
Name:DONNA J. BADOLATO, MD, PA
Entity Type:Organization
Organization Name:DONNA J. BADOLATO, MD, PA
Other - Org Name:DONNA JOHNSTON, MD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-751-7041
Mailing Address - Street 1:8061 SPYGLASS HILL RD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-751-7041
Mailing Address - Fax:321-751-7042
Practice Address - Street 1:8061 SPYGLASS HILL RD.
Practice Address - Street 2:SUITE 102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-751-7041
Practice Address - Fax:321-751-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7158131OtherAETNA INSURANCE
FL$$$$$$$$$OtherSOCIAL SECURITY NUMBER
FL49715OtherBLUE CROSS BLUE SHIELD
FLH21999Medicare UPIN