Provider Demographics
NPI:1720672850
Name:BALDWIN, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 FRANCES CRK
Mailing Address - Street 2:
Mailing Address - City:HARTS
Mailing Address - State:WV
Mailing Address - Zip Code:25524-8082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1166 FRANCES CRK
Practice Address - Street 2:
Practice Address - City:HARTS
Practice Address - State:WV
Practice Address - Zip Code:25524-8082
Practice Address - Country:US
Practice Address - Phone:304-855-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker