Provider Demographics
NPI:1891948196
Name:BALDEO, NOLI CANTUBA (MD)
Entity Type:Individual
Prefix:
First Name:NOLI
Middle Name:CANTUBA
Last Name:BALDEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MEDICAL PKWY
Mailing Address - Street 2:BUILDING B, SUITE 220
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7763
Mailing Address - Country:US
Mailing Address - Phone:512-324-4083
Mailing Address - Fax:512-324-4717
Practice Address - Street 1:201 SETON PKWY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8000
Practice Address - Country:US
Practice Address - Phone:713-441-5114
Practice Address - Fax:713-790-6615
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTMB PIT # BP10031324390200000X
TXP4285207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314797702Medicaid
TX314797704Medicaid
TX314797701Medicaid
TX314797703Medicaid
TX265152YKXVMedicare PIN
TX265152YLP1Medicare PIN
TX314797702Medicaid
TX314797703Medicaid
TX314797701Medicaid
TX314797704Medicaid