Provider Demographics
NPI:1518603729
Name:BALDECCHI, MARY W (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:W
Last Name:BALDECCHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3915 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1161
Mailing Address - Country:US
Mailing Address - Phone:804-502-3895
Mailing Address - Fax:
Practice Address - Street 1:1001 E LEIGH ST FL 12
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5004
Practice Address - Country:US
Practice Address - Phone:804-828-4396
Practice Address - Fax:804-828-0463
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024182503363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health