Provider Demographics
NPI:1639147911
Name:BALDWIN, CYNTHIA KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KATHLEEN
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:K
Other - Last Name:SHIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1890 LPGA BLVD
Mailing Address - Street 2:STE. 160
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7130
Mailing Address - Country:US
Mailing Address - Phone:386-252-4701
Mailing Address - Fax:386-253-9410
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:STE. 160
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7130
Practice Address - Country:US
Practice Address - Phone:386-252-4701
Practice Address - Fax:386-253-9410
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00551OtherBC/BS
FL064239800Medicaid
7673650OtherAETNA
U453AMedicare ID - Type Unspecified
FL064239800Medicaid