1912995945 NPI number — DR. ANTOINE BADLISSI M.D.

Table of content: DR. ANTOINE BADLISSI M.D. (NPI 1912995945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912995945 NPI number — DR. ANTOINE BADLISSI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADLISSI
Provider First Name:
ANTOINE
Provider Middle Name:
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:
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:
1912995945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 LIBBEY PKWY STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02189-3157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-682-0600
Provider Business Mailing Address Fax Number:
781-682-0601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 LIBBEY PKWY STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02189-3157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-682-0600
Provider Business Practice Location Address Fax Number:
781-682-0601
Provider Enumeration Date:
10/13/2005

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: 207R00000X , with the licence number:  55577 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 55577 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B10159201 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055577 . This is a "TUFTS ASSOCIATED HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103220 - 002 . This is a "UNITED HEALTH CARE OF NE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290014542 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J08383 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23056 . This is a "HARVARD PILGRIM HEALTH CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3046877 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000020812 . This is a "BOSTON HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004983 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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