Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 000490 | CT |
N | 207QA0505X | Family Doctor - Adult Medicine | 000490 | CT |
NPI | 1104895382 |
---|---|
Provider Name | Dr. Michael David Baldwin |
First Address | Essex, CT 06426-1154 |
Second Address | Essex, CT 06426-1154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 30/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001004902 | (05) | CT |
G69798 | (02) | CT |