Provider Demographics
NPI:1952144354
Name:BALDRIDGE, ANTHONY WAYNE (CAA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:WAYNE
Last Name:BALDRIDGE
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 WEYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1741
Mailing Address - Country:US
Mailing Address - Phone:216-386-7012
Mailing Address - Fax:
Practice Address - Street 1:1823 WEYMOUTH DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1741
Practice Address - Country:US
Practice Address - Phone:216-386-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000517367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant