Provider Demographics
NPI:1659316941
Name:D BADOLATO PA
Entity Type:Organization
Organization Name:D BADOLATO PA
Other - Org Name:PREMIER URGENT CAREBADOLATO FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BADOLATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-253-2169
Mailing Address - Street 1:6300 N WICKHAM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2028
Mailing Address - Country:US
Mailing Address - Phone:321-253-2169
Mailing Address - Fax:321-253-1720
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-253-2169
Practice Address - Fax:321-253-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3321Medicare ID - Type Unspecified
FL5755350001Medicare NSC