Provider Demographics
NPI:1023013323
Name:BALDWIN, BYRON N (PAC)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:N
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4124
Mailing Address - Country:US
Mailing Address - Phone:410-558-4900
Mailing Address - Fax:410-522-1475
Practice Address - Street 1:3509 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4124
Practice Address - Country:US
Practice Address - Phone:410-558-4900
Practice Address - Fax:410-522-1475
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC000414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P02718Medicare UPIN
S732-49EEMedicare ID - Type Unspecified