Provider Demographics
NPI:1447261748
Name:BADGER, DEBORAH A (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:BADGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HARRISON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3096
Mailing Address - Country:US
Mailing Address - Phone:315-464-6312
Mailing Address - Fax:315-464-8524
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3096
Practice Address - Country:US
Practice Address - Phone:315-464-6312
Practice Address - Fax:315-464-8524
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303464363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02494737Medicaid
NYRA1044Medicare PIN
NYP00436644Medicare PIN