Provider Demographics
NPI:1326000373
Name:BALDWIN-RAGAVEN, LAUREL E (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:E
Last Name:BALDWIN-RAGAVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:35 MIDDLEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1245
Mailing Address - Country:US
Mailing Address - Phone:860-297-4030
Mailing Address - Fax:860-297-4136
Practice Address - Street 1:99 WOODLAND ST
Practice Address - Street 2:ASYLUM HILL FAMILY MEDICINE CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1207
Practice Address - Country:US
Practice Address - Phone:860-714-4212
Practice Address - Fax:860-714-8080
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT039617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH97979Medicare UPIN