Healthcare Provider Details

I. General information

NPI: 1710912977
Provider Name (Legal Business Name): DAVID J BADOLATO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 FORT WASHINGTON AVE SUITE N1
FORT WASHINGTON PA
19034
US

IV. Provider business mailing address

1244 FORT WASHINGTON AVE SUITE N1
FORT WASHINGTON PA
19034
US

V. Phone/Fax

Practice location:
  • Phone: 215-646-1686
  • Fax: 215-628-4956
Mailing address:
  • Phone: 215-646-6504
  • Fax: 215-628-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD018235E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: