Provider Demographics
NPI:1881629491
Name:BADDIGAM, HARI K (MD)
Entity Type:Individual
Prefix:DR
First Name:HARI
Middle Name:K
Last Name:BADDIGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 STATE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4539
Mailing Address - Country:US
Mailing Address - Phone:850-763-8776
Mailing Address - Fax:
Practice Address - Street 1:2202 STATE AVE STE 104
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-763-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0085604174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265045200Medicaid
FL18006ZMedicare PIN
FLH64200Medicare UPIN