Healthcare Provider Details

I. General information

NPI: 1790750941
Provider Name (Legal Business Name): ELLIOTT M BADDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST PAUL PLACE 5TH FLOOR
BALTIMORE MD
21202
US

IV. Provider business mailing address

PO BOX 64028
BALTIMORE MD
21264-4028
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9404
  • Fax: 410-347-5599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0020293
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: