Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0103301127 | VA |
N | 222Z00000X | Podiatrist | 0103301127 | VA |
N | 213EP1101X | Primary Podiatric Medicine | 0103301127 | VA |
Y | 213ES0103X | Foot & Ankle Surgery | 0103301127 | VA |
N | 213ES0103X | Foot & Ankle Surgery | SC006378 | PA |
NPI | 1588928444 |
---|---|
Provider Name | James B Baldwin |
First Address | Glen Allen, VA 23060-4119 |
Second Address | Glen Allen, VA 23060-4119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 02/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0103301127 | VIRGINIA STATE MEDICAL LICENSE (01) | VA |
1588928444 | (05) | VA |