Basic Information
| Provider Information | |||||||||
| NPI: | 1013998970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADOLATO | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 534595 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303534595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216362111 | ||||||||
| FaxNumber: | 3216367180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 PINE ST | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329013119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216745050 | ||||||||
| FaxNumber: | 3219526296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 04/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | ME61815 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 110067794 | 01 | FL | RAILROAD MEDICARE | OTHER | 15118 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 03714 | 01 | FL | WELLCARE | OTHER | 373692000 | 05 | FL | MEDICAID | 4268178 | 01 | FL | AETNA | OTHER | 667172 | 01 | FL | AETNA | OTHER | 808490001 | 01 | FL | CIGNA | OTHER |