Provider Demographics
NPI:1629235619
Name:BADODARIYA, ANISH JAYANTILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANISH
Middle Name:JAYANTILAL
Last Name:BADODARIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LALITKUMAR
Other - Middle Name:JAYANTILAL
Other - Last Name:BADODARIYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 CAMELOT CT
Mailing Address - Street 2:APT. 401
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2551
Mailing Address - Country:US
Mailing Address - Phone:412-207-7800
Mailing Address - Fax:
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-285-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629235619Medicaid
VA1629235619Medicaid