Provider Demographics
NPI:1003371246
Name:BALDINO, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BALDINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EOD MOBILE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BASE GUAM
Practice Address - Street 2:EOD MOBILE UNIT 5
Practice Address - City:SANTA RITA
Practice Address - State:GU
Practice Address - Zip Code:96540
Practice Address - Country:US
Practice Address - Phone:585-749-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206244207PE0005X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine