Provider Demographics
NPI:1326023706
Name:BALDWIN, JENNIFER PURRINGTON (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PURRINGTON
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1610 MAXWELL DR STE 210
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-4004
Practice Address - Country:US
Practice Address - Phone:715-386-4004
Practice Address - Fax:715-386-5508
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69739-20207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I39249Medicare UPIN
MI0705210542OtherBLUE CROSS BLUE SHIELD
P21570001Medicare PIN
P00309377OtherRAILROAD MEDICARE
MI4778672Medicaid