Basic Information
| Provider Information | |||||||||
| NPI: | 1225131824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADULAK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 S HENDERSON RD | ||||||||
| Address2: | STE 308C | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103373111 | ||||||||
| FaxNumber: | 6103373506 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 S HENDERSON RD | ||||||||
| Address2: | STE 308C | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103373111 | ||||||||
| FaxNumber: | 6103373506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 05006960E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 588258 | 01 | PA | BCBS | OTHER |