Provider Demographics
NPI:1649012857
Name:BADOM, BARIDOR DAN
Entity type:Individual
Prefix:
First Name:BARIDOR
Middle Name:DAN
Last Name:BADOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 SUNNY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4079
Mailing Address - Country:US
Mailing Address - Phone:234-205-8242
Mailing Address - Fax:
Practice Address - Street 1:3207 SUNNY BROOK DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4079
Practice Address - Country:US
Practice Address - Phone:234-205-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 376J00000X
OH3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker