Provider Demographics
NPI:1912907502
Name:BADIE, BEDIOLA A (MD)
Entity Type:Individual
Prefix:
First Name:BEDIOLA
Middle Name:A
Last Name:BADIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BEDIOLA
Other - Middle Name:A
Other - Last Name:BADIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2617 SCRIPTURE ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2311
Mailing Address - Country:US
Mailing Address - Phone:940-382-4142
Mailing Address - Fax:940-382-7620
Practice Address - Street 1:2617 SCRIPTURE ST
Practice Address - Street 2:SUITE #101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2311
Practice Address - Country:US
Practice Address - Phone:940-382-4142
Practice Address - Fax:940-382-7620
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6962207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3452OtherBLUECROSS/BLUESHIELD
TX00DE96Medicare ID - Type Unspecified
TXC13042Medicare UPIN