MEDICARE: GEORGE NICHOLAS BALDWIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	158252-1205	UT

General Provider Information

NPI Number	:	1699914267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE NICHOLAS BALDWIN M.D.

Provider Business Mailing Address
First Line	:	3519 E. ARCATA RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4738
Country	:	US
Telephone Number	:	801-277-5337
Fax Number	:

Provider Business Practice Location Address
First Line	:	3519 E. ARCATA R
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4738
Country	:	US
Telephone Number	:	801-277-5337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	02/05/2009

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