Provider Demographics
NPI:1740400092
Name:BALTAZAR, CAROL RENDON (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:RENDON
Last Name:BALTAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8600 SNOWDEN RIVER PARKWAY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1986
Mailing Address - Country:US
Mailing Address - Phone:410-290-0012
Mailing Address - Fax:410-290-0015
Practice Address - Street 1:8600 SNOWDEN RIVER PARKWAY
Practice Address - Street 2:SUITE 307
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1986
Practice Address - Country:US
Practice Address - Phone:410-290-0012
Practice Address - Fax:410-290-0015
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0063185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine