Provider Demographics
NPI:1720179534
Name:BADER, PEARL J (MD)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:J
Last Name:BADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3825
Mailing Address - Country:US
Mailing Address - Phone:804-819-4000
Mailing Address - Fax:804-819-4268
Practice Address - Street 1:107 S 5TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3825
Practice Address - Country:US
Practice Address - Phone:804-819-4000
Practice Address - Fax:804-819-4268
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010469192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010141052Medicaid
VA260002377Medicare ID - Type Unspecified