Provider Demographics
NPI:1538395009
Name:JOSEPH P. BADOLATO, D.O., P.C.
Entity type:Organization
Organization Name:JOSEPH P. BADOLATO, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:BADOLATO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-468-2553
Mailing Address - Street 1:1818 E PASSYUNK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2128
Mailing Address - Country:US
Mailing Address - Phone:215-468-2553
Mailing Address - Fax:215-468-1096
Practice Address - Street 1:1818 E PASSYUNK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2128
Practice Address - Country:US
Practice Address - Phone:215-468-2553
Practice Address - Fax:215-468-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005061L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000124127OtherHIGHMARK BLUE SHIELD
PA4474097OtherAETNA
PA3727345000OtherINDEPENDENCE BLUE CROSS PERSONAL CHOICE
PA3727345001OtherKEYSTONE HEALTH PLAN EAST
1123759OtherCIGNA
276928OtherUNITED HEALTHCARE
30063423OtherKEYSTONE MERCY