MEDICARE: POORNIMA BADDI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	00000	MO
2	2080P0210X	Pediatric Nephrology Physician	4301106558	MI
3	2080P0210X	Pediatric Nephrology Physician	2011-01887	NC
4	208000000X	Pediatrics Physician	2011-01887	NC

General Provider Information

NPI Number	:	1487800611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POORNIMA BADDI MD

Provider Business Mailing Address
First Line	:	10410 PARK RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-6568
Country	:	US
Telephone Number	:	573-891-9127
Fax Number	:

Provider Business Practice Location Address
First Line	:	10410 PARK RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-6568
Country	:	US
Telephone Number	:	573-891-9127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	09/07/2022

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Directions to “ POORNIMA BADDI MD” Practice Location

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