Provider Demographics
NPI:1548419419
Name:BALDWIN, KIYANDA NYREE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIYANDA
Middle Name:NYREE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 FALL HILL AVE STE 509
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3343
Mailing Address - Country:US
Mailing Address - Phone:540-741-2277
Mailing Address - Fax:540-741-1029
Practice Address - Street 1:125 HOSPITAL CENTER BLVD STE 201
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6203
Practice Address - Country:US
Practice Address - Phone:540-374-3212
Practice Address - Fax:540-374-3224
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252582208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548419419Medicaid