Provider Demographics
NPI:1013998970
Name:BADOLATO, CRAIG J (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:BADOLATO
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:PO BOX 534595
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4595
Mailing Address - Country:US
Mailing Address - Phone:321-636-2111
Mailing Address - Fax:321-636-7180
Practice Address - Street 1:1430 PINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3119
Practice Address - Country:US
Practice Address - Phone:321-674-5050
Practice Address - Fax:321-952-6296
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61815207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110067794OtherRAILROAD MEDICARE
FL15118OtherBLUE CROSS BLUE SHIELD
FL03714OtherWELLCARE
FL373692000Medicaid
FL4268178OtherAETNA
FL667172OtherAETNA
FL808490001OtherCIGNA
FL808490001OtherCIGNA
FL373692000Medicaid
E40815Medicare UPIN