Provider Demographics
NPI:1972532679
Name:BADESHA, PRITAM S (MD)
Entity type:Individual
Prefix:
First Name:PRITAM
Middle Name:S
Last Name:BADESHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRITAM
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1801 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3028
Mailing Address - Country:US
Mailing Address - Phone:661-632-1801
Mailing Address - Fax:661-632-1866
Practice Address - Street 1:1801 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3028
Practice Address - Country:US
Practice Address - Phone:661-632-1801
Practice Address - Fax:661-632-1866
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG68719Medicare UPIN