Provider Demographics
NPI:1710035738
Name:BALDWIN, SCOTT WILLIAMS (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WILLIAMS
Last Name:BALDWIN
Suffix:
Gender:M
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:PO BOX 321273
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0121
Mailing Address - Country:US
Mailing Address - Phone:408-358-1855
Mailing Address - Fax:408-628-0153
Practice Address - Street 1:2450 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3912
Practice Address - Country:US
Practice Address - Phone:408-358-1855
Practice Address - Fax:408-628-0153
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95409208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03344983Medicaid
NY03344983Medicaid