Provider Demographics
NPI:1912995945
Name:BADLISSI, ANTOINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINE
Middle Name:
Last Name:BADLISSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LIBBEY PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3157
Mailing Address - Country:US
Mailing Address - Phone:781-682-0600
Mailing Address - Fax:781-682-0601
Practice Address - Street 1:90 LIBBEY PKWY STE 201
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3157
Practice Address - Country:US
Practice Address - Phone:781-682-0600
Practice Address - Fax:781-682-0601
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55577207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B10159201OtherCIGNA HEALTH CARE
055577OtherTUFTS ASSOCIATED HEALTH P
103220 - 002OtherUNITED HEALTH CARE OF NE
290014542OtherRAILROAD MEDICARE
J08383OtherBLUE CROSS/BLUE SHIELD
23056OtherHARVARD PILGRIM HEALTH CA
MA3046877Medicaid
000000020812OtherBOSTON HEALTH NET
0004983OtherNEIGHBORHOOD HEALTH PLAN
23056OtherHARVARD PILGRIM HEALTH CA
MAD93035Medicare UPIN