Provider Demographics
NPI:1255390944
Name:BAPTIST, GLADWYN D (MD)
Entity type:Individual
Prefix:DR
First Name:GLADWYN
Middle Name:D
Last Name:BAPTIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 MAGNOLIA AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1760
Mailing Address - Country:US
Mailing Address - Phone:856-455-2222
Mailing Address - Fax:856-455-6541
Practice Address - Street 1:10 MAGNOLIA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1760
Practice Address - Country:US
Practice Address - Phone:856-455-2222
Practice Address - Fax:856-455-6541
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03666500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3711200Medicaid
NJ3711200Medicaid
NJ444230Medicare ID - Type Unspecified