Provider Demographics
NPI:1598711244
Name:BALDWIN, TONIA M (MD)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:M
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1174
Mailing Address - Country:US
Mailing Address - Phone:712-542-5634
Mailing Address - Fax:712-542-6112
Practice Address - Street 1:2000 N 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1174
Practice Address - Country:US
Practice Address - Phone:712-542-5634
Practice Address - Fax:712-542-6112
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2267740Medicaid
IAI10721Medicare ID - Type Unspecified
IAH65601Medicare UPIN