MEDICARE: THOMAS BALDRIDGE

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1962825042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS BALDRIDGE

Provider Business Mailing Address
First Line	:	USS DALLAS SSN 700
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09567-2380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS DALLAS SSN 700
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09567-2380
Country	:	US
Telephone Number	:	860-694-4290
Fax Number	:

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

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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Directions to “ THOMAS BALDRIDGE ” Practice Location

Language	Start Address	Practice Location

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