Basic Information
| Provider Information | |||||||||
| NPI: | 1467558577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BADDIGAM | ||||||||
| FirstName: | KRISHNAMOHAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 PROVIDENCE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
| FaxNumber: | 7047495819 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 PROVIDENCE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
| FaxNumber: | 7047495819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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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 | 207L00000X | 2009-01794 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 2009-01794 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | 2009-01794 | NC | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5913791 | 05 | NC | MEDICAID |