Provider Demographics
NPI:1568553386
Name:BALDO, EDNA REYES (MD)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:REYES
Last Name:BALDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6857 COMPTON HTS CIR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124
Mailing Address - Country:US
Mailing Address - Phone:703-815-2250
Mailing Address - Fax:
Practice Address - Street 1:8136 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152
Practice Address - Country:US
Practice Address - Phone:703-569-1031
Practice Address - Fax:703-455-1725
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010350392083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E63743Medicare UPIN