Provider Demographics
NPI:1376500181
Name:BALDUINI, FREDERICK CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CHARLES
Last Name:BALDUINI
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 1:2779 W HORIZON RIDGE
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4380
Mailing Address - Country:US
Mailing Address - Phone:702-990-2290
Mailing Address - Fax:702-990-2297
Practice Address - Street 1:2779 W HORIZON RIDGE
Practice Address - Street 2:STE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4380
Practice Address - Country:US
Practice Address - Phone:702-990-2290
Practice Address - Fax:702-990-2297
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04482900207XX0005X
NV13681207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC31096Medicare UPIN
NJC31096Medicare UPIN
C31096Medicare UPIN
NJ579829Medicare ID - Type Unspecified