Provider Demographics
NPI:1285683516
Name:BALDWIN, KITTREDGE ALEXANDER (DO)
Entity Type:Individual
Prefix:
First Name:KITTREDGE
Middle Name:ALEXANDER
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-830-1706
Mailing Address - Fax:
Practice Address - Street 1:2011 NW MYHRE PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8561
Practice Address - Country:US
Practice Address - Phone:360-830-1706
Practice Address - Fax:360-830-1780
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001740207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA158446OtherLABOR & INDUSTRIES
WA8297046Medicaid
7352369OtherAETNA
9617BAOtherREGENCE BLUESHIELD
290014550OtherRAILROAD MEDICARE
290014550OtherRAILROAD MEDICARE
G8892275Medicare PIN
WA8297046Medicaid
BB5456353OtherDEA
H59940Medicare UPIN
WAGAB28127Medicare PIN
G8894063Medicare PIN
WAG8852214Medicare PIN
7352369OtherAETNA
WAGAB28129Medicare PIN