Individual
FADI BADLISSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
545A CENTRE ST, JAMAICA PLAIN, MA 02130-2061
(617) 522-5464
(617) 524-2966
Mailing address
545A CENTRE ST, URBAN MEDICAL GROUP,, JAMAICA PLAIN, MA 02130-2061
(617) 522-5464
(617) 524-2966
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
158553
MA
207RR0500X
Rheumatology Physician
Primary
158553
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2024811
—
MA
Enumeration date
10/17/2005
Last updated
05/14/2008
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