Provider Demographics
NPI:1851379960
Name:BALTAZAR, RODNEY (DO)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:
Last Name:BALTAZAR
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 1:319 MALONEY RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6320
Mailing Address - Country:US
Mailing Address - Phone:410-620-0493
Mailing Address - Fax:
Practice Address - Street 1:120 SANDHILL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5806
Practice Address - Country:US
Practice Address - Phone:302-449-1988
Practice Address - Fax:302-449-1998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0006227207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001144404Medicaid
DEG01622Medicare ID - Type Unspecified
G83055Medicare UPIN
MD104M995EMedicare ID - Type Unspecified