Healthcare Provider Details

I. General information

NPI: 1134184161
Provider Name (Legal Business Name): WALID G BADER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BOSTON ST
LYNN MA
01904-2538
US

IV. Provider business mailing address

191-205 PARKINGWAY
QUINCY MA
02169-5011
US

V. Phone/Fax

Practice location:
  • Phone: 781-342-4191
  • Fax: 833-450-5157
Mailing address:
  • Phone: 617-820-5968
  • Fax: 833-471-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number224414
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1117
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: