Provider Demographics
NPI:1104853092
Name:BALDWIN, DOUGLAS RAWLING (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RAWLING
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-2987
Practice Address - Fax:651-254-1603
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36943208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN36943OtherLICENSE
MN36943OtherLICENSE
N85390001Medicare PIN
MI3305210462OtherBLUE CROSS BLUE SHIELD
F84916Medicare UPIN
MI4603433Medicaid