Provider Demographics
NPI:1578756854
Name:JENNIFER P. BALDWIN, M.D., P.L.C.
Entity Type:Organization
Organization Name:JENNIFER P. BALDWIN, M.D., P.L.C.
Other - Org Name:SUPERIOR DERMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-7920
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 342
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-7920
Mailing Address - Fax:906-225-3975
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 342
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-7920
Practice Address - Fax:906-225-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE6903OtherRAILROAD MEDICARE
0P21570Medicare PIN