Provider Demographics
NPI:1417137472
Name:JAMES BALDYS
Entity Type:Organization
Organization Name:JAMES BALDYS
Other - Org Name:SOUTH SIDE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALDYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-327-1335
Mailing Address - Street 1:699 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-7606
Mailing Address - Country:US
Mailing Address - Phone:570-327-1335
Mailing Address - Fax:570-321-7800
Practice Address - Street 1:699 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-7606
Practice Address - Country:US
Practice Address - Phone:570-327-1335
Practice Address - Fax:570-321-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034300E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025687Medicare PIN