Provider Demographics
NPI:1215993928
Name:BADDICK, PETER J III (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:BADDICK
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 BLAKESLEE BOULEVARD DR W
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9776
Mailing Address - Country:US
Mailing Address - Phone:570-386-4171
Mailing Address - Fax:570-386-2429
Practice Address - Street 1:2175 BLAKESLEE BOULEVARD DR W
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9776
Practice Address - Country:US
Practice Address - Phone:570-386-4171
Practice Address - Fax:570-386-2429
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008960-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010063548OtherRAILROAD MEDICARE ID
PA885601OtherHIGHMARK ID
PA5647041OtherAETNA ID NON HMO
PA0015989840002Medicaid
PA010063548OtherRAILROAD MEDICARE ID
PA0015989840002Medicaid