Healthcare Provider Details

I. General information

NPI: 1225101256
Provider Name (Legal Business Name): ANDREW J. BALDWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 836 BOX 316
FPO AE
09636-0006
US

IV. Provider business mailing address

PSC 836 BOX 316
FPO AE
09636-0006
US

V. Phone/Fax

Practice location:
  • Phone: 619-512-7500
  • Fax:
Mailing address:
  • Phone: 619-512-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number152300
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCX3200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: