Provider Demographics
NPI:1265861264
Name:ALVARO R. BADA, M.D., P.A.
Entity type:Organization
Organization Name:ALVARO R. BADA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:R
Authorized Official - Last Name:BADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-255-0069
Mailing Address - Street 1:18308 MURDOCK CIR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1025
Mailing Address - Country:US
Mailing Address - Phone:941-255-0069
Mailing Address - Fax:941-255-0072
Practice Address - Street 1:18308 MURDOCK CIR UNIT 101
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1025
Practice Address - Country:US
Practice Address - Phone:941-255-0069
Practice Address - Fax:941-255-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39970208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043820100Medicaid
FL34054Medicare PIN
FLD85614Medicare UPIN