Healthcare Provider Details

I. General information

NPI: 1578142162
Provider Name (Legal Business Name): DYLAN JESSE BADIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 S RIVER RD STE 205
BEDFORD NH
03110-0137
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 603-956-6390
  • Fax: 603-956-6388
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number24728
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number24728
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: