Provider Demographics
NPI:1710912977
Name:BADOLATO, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BADOLATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1244 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE N1
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034
Mailing Address - Country:US
Mailing Address - Phone:215-646-6504
Mailing Address - Fax:215-628-4956
Practice Address - Street 1:1244 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE N1
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034
Practice Address - Country:US
Practice Address - Phone:215-646-1686
Practice Address - Fax:215-628-4956
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD018235E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B34051Medicare UPIN
PA037870FXQMedicare ID - Type Unspecified