Healthcare Provider Details

I. General information

NPI: 1851379960
Provider Name (Legal Business Name): RODNEY BALTAZAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SANDHILL DR
MIDDLETOWN DE
19709-5806
US

IV. Provider business mailing address

319 MALONEY RD
ELKTON MD
21921-6320
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-1988
  • Fax: 302-449-1998
Mailing address:
  • Phone: 410-620-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC2-0006227
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: