Provider Demographics
NPI:1740235969
Name:BALDONE DERMATOLOGY, APMC
Entity Type:Organization
Organization Name:BALDONE DERMATOLOGY, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-892-3376
Mailing Address - Street 1:150 LAKEVIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-892-3376
Mailing Address - Fax:985-892-2055
Practice Address - Street 1:150 LAKEVIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-892-3376
Practice Address - Fax:985-892-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU18Medicare PIN