Provider Demographics
NPI:1851354104
Name:BALDWIN, KELLY CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CHRISTOPHER
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2598
Mailing Address - Country:US
Mailing Address - Phone:615-867-8060
Mailing Address - Fax:615-893-2590
Practice Address - Street 1:1272 GARRISON DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2598
Practice Address - Country:US
Practice Address - Phone:615-867-8060
Practice Address - Fax:615-893-2590
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008713208800000X
TN2881208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH150257Medicare UPIN
OHP00318445Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH2645089Medicaid
OH000000480373OtherANTHEM
OH150257Medicare UPIN
OH4178803Medicare ID - Type UnspecifiedOFFICE LOCATION 3
OH4178802Medicare ID - Type UnspecifiedOFFICE LOCATION 2
OH4178801Medicare ID - Type UnspecifiedOFFICE LOCATION 1