Healthcare Provider Details

I. General information

NPI: 1013998970
Provider Name (Legal Business Name): CRAIG J BADOLATO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PINE ST
MELBOURNE FL
32901-3119
US

IV. Provider business mailing address

PO BOX 534595
ATLANTA GA
30353-4595
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-5050
  • Fax: 321-952-6296
Mailing address:
  • Phone: 321-636-2111
  • Fax: 321-636-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME61815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: