Healthcare Provider Details

I. General information

NPI: 1831114818
Provider Name (Legal Business Name): THOMAS J BADER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER BLVD ACP #334
UPLAND PA
19013-3902
US

IV. Provider business mailing address

1350 EDGMONT AVE STE 1500
CHESTER PA
19013-3962
US

V. Phone/Fax

Practice location:
  • Phone: 610-872-7660
  • Fax: 610-876-2628
Mailing address:
  • Phone: 610-872-7660
  • Fax: 610-876-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD045194L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: