Healthcare Provider Details

I. General information

NPI: 1962662478
Provider Name (Legal Business Name): DONNA BALDASSARE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S GRANT ST
SAN MATEO CA
94402-2666
US

IV. Provider business mailing address

1875 S GRANT ST STE 760
SAN MATEO CA
94402-2670
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-8884
  • Fax:
Mailing address:
  • Phone: 707-442-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2016-02456
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number23709
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016-02456
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number2016-02456
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102203602
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83751
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: