1508802331 NPI number — DEBORAH L BADRO CRNP

Table of content: DEBORAH L BADRO CRNP (NPI 1508802331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508802331 NPI number — DEBORAH L BADRO CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADRO
Provider First Name:
DEBORAH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508802331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64042
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-787-4830
Provider Business Mailing Address Fax Number:
410-595-1933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8601 VETERANS HWY
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
MILLERSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21108-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-729-0424
Provider Business Practice Location Address Fax Number:
410-729-0492
Provider Enumeration Date:
06/21/2006

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: 363L00000X , with the licence number:  R104338 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42400500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: O242-0017 . This is a "CARE FIRST BLUE CROSS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 208212 . This is a "JOHNS HOPKINS HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 68687203 . This is a "CARE FIRST BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6003 . This is a "BRAVO/ELDER HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 69913 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 858052 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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