Provider Demographics
NPI:1235279688
Name:BALDWIN, NATHAN WARD (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WARD
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-0070
Mailing Address - Country:US
Mailing Address - Phone:662-720-1600
Mailing Address - Fax:662-720-1664
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:662-720-1600
Practice Address - Fax:662-720-1664
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15031207Q00000X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117392Medicaid
MS110001824Medicare ID - Type UnspecifiedMCARE INDIVIDUAL ID#
MS00117392Medicaid