MEDICARE: FREDERICK CHARLES BADER PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS008795L	PA

General Provider Information

NPI Number	:	1770933392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK CHARLES BADER PSY.D.

Provider Business Mailing Address
First Line	:	1231 NORTH BROAD STREET
Second Line	:	5TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122
Country	:	US
Telephone Number	:	215-627-8671
Fax Number	:	215-763-5774

Provider Business Practice Location Address
First Line	:	1231 NORTH BROAD STREET
Second Line	:	5TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122
Country	:	US
Telephone Number	:	215-627-8671
Fax Number	:	215-763-5774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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