Healthcare Provider Details

I. General information

NPI: 1740235969
Provider Name (Legal Business Name): BALDONE DERMATOLOGY, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LAKEVIEW CIRCLE
COVINGTON LA
70433
US

IV. Provider business mailing address

150 LAKEVIEW CIRCLE
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-3376
  • Fax: 985-892-2055
Mailing address:
  • Phone: 985-892-3376
  • Fax: 985-892-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number021944
License Number StateLA

VIII. Authorized Official

Name: RHONDA R. BALDONE
Title or Position: OWNER
Credential: M.D.
Phone: 985-892-3376