Provider Demographics
NPI:1417257825
Name:BALDWIN, LEAH MARIE (IDC)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:MARIE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3708
Mailing Address - Country:US
Mailing Address - Phone:619-318-5168
Mailing Address - Fax:
Practice Address - Street 1:55 GEORGE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-3708
Practice Address - Country:US
Practice Address - Phone:619-318-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman