Provider Demographics
NPI:1134862063
Name:BACTAWAR, AIRADA DAAMDEE (MD)
Entity type:Individual
Prefix:
First Name:AIRADA
Middle Name:DAAMDEE
Last Name:BACTAWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AIRADA
Other - Middle Name:DAAMDEE
Other - Last Name:BRICKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:250 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1760
Mailing Address - Country:US
Mailing Address - Phone:270-796-6540
Mailing Address - Fax:270-796-6576
Practice Address - Street 1:250 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1760
Practice Address - Country:US
Practice Address - Phone:270-796-6540
Practice Address - Fax:270-796-6576
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program