Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 706 | NC |
Y | 222Z00000X | Podiatrist | 706 | NC |
N | 213E00000X | Podiatrist | SC006652 | PA |
N | 222Z00000X | Podiatrist | SC006652 | PA |
N | 213EP1101X | Primary Podiatric Medicine | 706 | NC |
N | 213ES0103X | Foot & Ankle Surgery | SC006652 | PA |
NPI | 1255726071 |
---|---|
Provider Name | Dr. Adam Badaczewski |
First Address | Charlotte, NC 28260-0447 |
Second Address | Winston Salem, NC 27103-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103485196 | (05) | PA |