1154342145 NPI number — DR. NADER TALAT BADDAR M.D.

Table of content: DR. NADER TALAT BADDAR M.D. (NPI 1154342145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154342145 NPI number — DR. NADER TALAT BADDAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADDAR
Provider First Name:
NADER
Provider Middle Name:
TALAT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BADDAR
Provider Other First Name:
NADER
Provider Other Middle Name:
TALAT
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154342145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 THIMBLE SHOALS BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-4544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-240-5580
Provider Business Mailing Address Fax Number:
757-240-5578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
593 ABERDEEN RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23661-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-825-1100
Provider Business Practice Location Address Fax Number:
757-838-2034
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  0101037720 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: 0101037720 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0505X , with the licence number: 0101037720 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 208497 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320923 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 268197 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005641144 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174879 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 60054NOCD . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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