Healthcare Provider Details

I. General information

NPI: 1710315494
Provider Name (Legal Business Name): MICHAEL BADER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
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

92 MONTVALE AVE SUITE 3700
STONEHAM MA
02180-3647
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-5543
  • Fax: 781-438-2001
Mailing address:
  • Phone: 781-438-5543
  • Fax: 781-438-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIDGET CLARK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 781-438-5543