Healthcare Provider Details

I. General information

NPI: 1326219882
Provider Name (Legal Business Name): MICHAEL BADER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MONTVALE AVE SUITE 3700
STONEHAM MA
02180-3647
US

IV. Provider business mailing address

PO BOX 760
WINCHESTER MA
01890-4260
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-5543
  • Fax: 781-756-7274
Mailing address:
  • Phone: 781-756-7273
  • Fax: 781-756-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52061
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number52061
License Number StateMA

VIII. Authorized Official

Name: MICHAEL BRADLEY BADER
Title or Position: OWNER
Credential: MD
Phone: 781-438-5543