Provider Demographics
NPI:1740698265
Name:BALDWIN, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26168 BOSCH LN
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:MD
Mailing Address - Zip Code:21830-2214
Mailing Address - Country:US
Mailing Address - Phone:302-233-0443
Mailing Address - Fax:
Practice Address - Street 1:26168 BOSCH LN
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:MD
Practice Address - Zip Code:21830-2214
Practice Address - Country:US
Practice Address - Phone:302-233-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB435469067990390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program