Provider Demographics
NPI:1003956459
Name:NATHAN W BALDWIN MD PA
Entity Type:Organization
Organization Name:NATHAN W BALDWIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-720-1600
Mailing Address - Street 1:100 HOSPITAL ST STE 100
Mailing Address - Street 2:P. O. BOX 70
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-3354
Mailing Address - Country:US
Mailing Address - Phone:662-720-1600
Mailing Address - Fax:662-720-1172
Practice Address - Street 1:100 HOSPITAL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3354
Practice Address - Country:US
Practice Address - Phone:662-820-1600
Practice Address - Fax:662-720-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15031207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015455Medicaid
MS09015455Medicaid