Healthcare Provider Details

I. General information

NPI: 1487800611
Provider Name (Legal Business Name): POORNIMA BADDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: POORNIMA CHINTALAPALLI MD

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 PARK RD STE 100
CHARLOTTE NC
28210-6568
US

IV. Provider business mailing address

10410 PARK RD STE 100
CHARLOTTE NC
28210-6568
US

V. Phone/Fax

Practice location:
  • Phone: 573-891-9127
  • Fax:
Mailing address:
  • Phone: 573-891-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00000
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number4301106558
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number2011-01887
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2011-01887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: