Provider Demographics
NPI:1639249212
Name:BADAR, MARIA ROSARIO (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ROSARIO
Last Name:BADAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:R
Other - Last Name:AYAEA BADAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3820 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE STATION
Mailing Address - State:IN
Mailing Address - Zip Code:46405
Mailing Address - Country:US
Mailing Address - Phone:219-962-4070
Mailing Address - Fax:219-962-4070
Practice Address - Street 1:3820 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE STATION
Practice Address - State:IN
Practice Address - Zip Code:46405
Practice Address - Country:US
Practice Address - Phone:219-962-4070
Practice Address - Fax:219-962-4070
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027374A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084099OtherBC BS ANTHEM
EO5574Medicare UPIN
IN497690Medicare ID - Type Unspecified