Provider Demographics
NPI:1154342145
Name:BADDAR, NADER TALAT (MD)
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:TALAT
Last Name:BADDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NADER
Other - Middle Name:TALAT
Other - Last Name:BADDAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:704 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4544
Mailing Address - Country:US
Mailing Address - Phone:757-240-5580
Mailing Address - Fax:757-240-5578
Practice Address - Street 1:593 ABERDEEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-1332
Practice Address - Country:US
Practice Address - Phone:757-825-1100
Practice Address - Fax:757-838-2034
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010377202083X0100X, 208D00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA208497OtherANTHEM
VA320923OtherANTHEM
VA268197OtherANTHEM
VA005641144Medicaid
VA174879OtherANTHEM
VA60054NOCDOtherAETNA
VA320923OtherANTHEM
VA268197OtherANTHEM
VA208497OtherANTHEM
VAB-59847Medicare UPIN
VA110006417Medicare PIN