Healthcare Provider Details

I. General information

NPI: 1659529808
Provider Name (Legal Business Name): JENNIFER REBECCA BADIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE SUITE #311
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

301 E WENDOVER AVE SUITE #311
GREENSBORO NC
27401-1230
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-6161
  • Fax: 336-230-2150
Mailing address:
  • Phone: 336-272-6161
  • Fax: 336-230-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD486612
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number62862
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number201201397
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: