Provider Demographics
NPI:1912346024
Name:BADHIWALA, NIRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:
Last Name:BADHIWALA
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 1:801 W I 20 STE 1
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5851
Mailing Address - Country:US
Mailing Address - Phone:817-784-8268
Mailing Address - Fax:817-417-1151
Practice Address - Street 1:801 W I 20 STE 1
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5851
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-417-1151
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013020258208600000X
TXR6335208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387302803Medicaid
TX387302801Medicaid
TX387302802Medicaid