Healthcare Provider Details

I. General information

NPI: 1194958918
Provider Name (Legal Business Name): DRS. BALDWIN, HORNBAKE AND SPAGNOLA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WILDWOOD MEDICAL CTR
ESSEX CT
06426-1154
US

IV. Provider business mailing address

10 WILDWOOD MEDICAL CENTER
ESSEX CT
06426-1154
US

V. Phone/Fax

Practice location:
  • Phone: 860-767-0145
  • Fax: 860-767-0021
Mailing address:
  • Phone: 860-767-0145
  • Fax: 860-767-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EARL RODNEY HORNBAKE III
Title or Position: PRESIDENT
Credential: MD
Phone: 860-767-0145