Provider Demographics
NPI:1265700611
Name:BALDWIN, ABIGAIL JOY (PT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JOY
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:2314 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3730
Practice Address - Country:US
Practice Address - Phone:410-287-2940
Practice Address - Fax:410-287-2941
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
DEJ1-0002768225100000X
MD23903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1265700611Medicaid
MDP01340247Medicare PIN
DE264404Y0XMedicare PIN
MD232999ZBL8Medicare PIN