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General NPI Number Information
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NPI Number | 1053935775
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Entity Type | Individual
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Provider Name | ALEXANDER WAFIC BARADEI MD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1805 N CALIFORNIA ST STE 201
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City | STOCKTON
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State | CA
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Zip | 95204-6032
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Country | US
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Telephone | 209-645-4005
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Fax | 209-645-6344
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Provider Business Mailing Address
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Address Line | 35 FOLLY ROAD BLVD UNIT 201
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City | CHARLESTON
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State | SC
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Zip | 29407-2596
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Country | US
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Telephone | 678-778-9634
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LL84152
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A200079
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A200079
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License Number State | CA
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