Provider Demographics
NPI:1891704698
Name:BARALDI, CAROLE A (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:A
Last Name:BARALDI
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:PO BOX 95970
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0970
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:24 S 1100 E
Practice Address - Street 2:209
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:801-208-5938
Practice Address - Fax:801-350-4753
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341812-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528175800002Medicaid
UT005569009Medicare PIN
UT528175800002Medicaid