Provider Demographics
NPI:1780006015
Name:BALDECK, ANDREA MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MAE
Last Name:BALDECK
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 1:6122 BUTLER PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2604
Mailing Address - Country:US
Mailing Address - Phone:215-540-1886
Mailing Address - Fax:215-540-1887
Practice Address - Street 1:6122 BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2604
Practice Address - Country:US
Practice Address - Phone:215-540-1886
Practice Address - Fax:215-540-1887
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-025503-E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine