Provider Demographics
NPI:1336150069
Name:BALDWIN, POLLY F (MD)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:F
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 STATE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2429
Mailing Address - Country:US
Mailing Address - Phone:805-617-7850
Mailing Address - Fax:805-898-2002
Practice Address - Street 1:1900 STATE ST
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2429
Practice Address - Country:US
Practice Address - Phone:805-617-7850
Practice Address - Fax:805-898-2002
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A761900Medicaid
CAH53660Medicare UPIN
CA00A761900Medicaid