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General NPI Number Information
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NPI Number | 1053567172
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Entity Type | Individual
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Provider Name | DOV A BADER MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 1850 E PARK AVE SUITE 112
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City | STATE COLLEGE
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State | PA
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Zip | 16803-6706
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Country | US
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Telephone | 814-865-3566
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Fax | 814-863-7803
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Provider Business Mailing Address
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Address Line | PO BOX 858 MC A410
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City | HERSHEY
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State | PA
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Zip | 17033-0858
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Country | US
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Telephone | 800-243-1455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD438026
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | MD438026
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License Number State | PA
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