Provider Demographics
NPI:1962666305
Name:AHMAD FARID BADERY, MD, P.C.
Entity Type:Organization
Organization Name:AHMAD FARID BADERY, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:FARID
Authorized Official - Last Name:BADERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-544-3849
Mailing Address - Street 1:1350 E FLAMINGO RD
Mailing Address - Street 2:STE 174
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5226
Mailing Address - Country:US
Mailing Address - Phone:702-544-3849
Mailing Address - Fax:
Practice Address - Street 1:2470 E FLAMINGO RD
Practice Address - Street 2:#D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5200
Practice Address - Country:US
Practice Address - Phone:702-544-3849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBF502Medicare PIN
NVI48014Medicare UPIN