Provider Demographics
NPI:1356545743
Name:GLADWYN D. BAPTIST, MD, PA
Entity type:Organization
Organization Name:GLADWYN D. BAPTIST, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADWYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAPTIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-455-2222
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03666500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3711200Medicaid
NJ3711200Medicaid
NJC54083Medicare UPIN