Healthcare Provider Details

I. General information

NPI: 1518192350
Provider Name (Legal Business Name): MATTHEW THOMAS BADER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 UNIVERSITY DR STE 100
DURHAM NC
27707-6208
US

IV. Provider business mailing address

3710 UNIVERSITY DR STE 100
DURHAM NC
27707-6208
US

V. Phone/Fax

Practice location:
  • Phone: 919-906-4390
  • Fax: 919-287-2707
Mailing address:
  • Phone: 919-906-4390
  • Fax: 919-287-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2014-00872
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number2014-00872
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: