Provider Demographics
NPI:1699509059
Name:ANTHONY J BADAME MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANTHONY J BADAME MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-828-0284
Mailing Address - Street 1:2025 FOREST AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4806
Mailing Address - Country:US
Mailing Address - Phone:408-297-4200
Mailing Address - Fax:408-297-2503
Practice Address - Street 1:2025 FOREST AVE STE 9
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4806
Practice Address - Country:US
Practice Address - Phone:408-297-4200
Practice Address - Fax:408-297-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty