Provider Demographics
NPI:1558072850
Name:BALDERSON, BARRY ALLAN
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ALLAN
Last Name:BALDERSON
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 1:401 BROADWAY STE C
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1749
Mailing Address - Country:US
Mailing Address - Phone:440-538-0022
Mailing Address - Fax:
Practice Address - Street 1:401 BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1743
Practice Address - Country:US
Practice Address - Phone:440-538-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator