Healthcare Provider Details

I. General information

NPI: 1477533602
Provider Name (Legal Business Name): SEEMA ANIL BADVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 HIGHWAY 613
MOSS POINT MS
39562-8200
US

IV. Provider business mailing address

PO BOX 1358
ESCATAWPA MS
39552-1358
US

V. Phone/Fax

Practice location:
  • Phone: 228-475-1166
  • Fax: 228-475-9337
Mailing address:
  • Phone: 228-475-1166
  • Fax: 228-475-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00026787
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00026787
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number00026787
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19919
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: