Provider Demographics
NPI:1487632311
Name:BALDERSTON, VIRGINIA MARIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MARIAN
Last Name:BALDERSTON
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 1:5318 RANALLI DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9653
Mailing Address - Country:US
Mailing Address - Phone:724-449-9355
Mailing Address - Fax:724-449-2727
Practice Address - Street 1:5318 RANALLI DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9653
Practice Address - Country:US
Practice Address - Phone:724-449-9355
Practice Address - Fax:724-449-2727
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045329L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001536060000Medicaid
PAG09881Medicare UPIN
PA787174Medicare ID - Type Unspecified