Provider Demographics
NPI:1437826633
Name:BALD, GORDON ANDREW
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:ANDREW
Last Name:BALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BOBTAIL WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-2439
Mailing Address - Country:US
Mailing Address - Phone:513-292-1647
Mailing Address - Fax:
Practice Address - Street 1:42 E CRESCENTVILLE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1302
Practice Address - Country:US
Practice Address - Phone:701-858-1801
Practice Address - Fax:513-671-7110
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN388339163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse