Healthcare Provider Details

I. General information

NPI: 1114127420
Provider Name (Legal Business Name): JEHANGIR BADAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 VARNUM AVE
LOWELL MA
01854-2134
US

IV. Provider business mailing address

47 HIGH STREET SUITE 101
NORTH ANDOVER MA
01845
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-6439
  • Fax:
Mailing address:
  • Phone: 978-258-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number37165
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number290489
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD446869
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number290489
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD446869
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: