1578787941 NPI number — DONNA J. BADOLATO, MD, PA

Table of content: (NPI 1578787941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578787941 NPI number — DONNA J. BADOLATO, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONNA J. BADOLATO, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1578787941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8061 SPYGLASS HILL RD.
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-751-7041
Provider Business Mailing Address Fax Number:
321-751-7042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8061 SPYGLASS HILL RD.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-751-7041
Provider Business Practice Location Address Fax Number:
321-751-7042
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
321-751-7041

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME76813 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7158131 . This is a "AETNA INSURANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 49715 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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