Provider Demographics
NPI:1619408176
Name:BADAMI, ANJALI
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:BADAMI
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 1:1365 CLIFTON RD NE BLDG B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-2689
Mailing Address - Country:US
Mailing Address - Phone:404-778-2020
Mailing Address - Fax:
Practice Address - Street 1:1160 VARNUM ST NE STE 11
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2110
Practice Address - Country:US
Practice Address - Phone:202-529-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351041076207W00000X
GA88233207W00000X
DCMD210002612207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD987288400Medicaid
DC054480059Medicaid