Healthcare Provider Details

I. General information

NPI: 1831142652
Provider Name (Legal Business Name): DAVID BALDONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 HIGHWAY 190 EAST SERVICE RD
COVINGTON LA
70433-4957
US

IV. Provider business mailing address

PO BOX 833
MANDEVILLE LA
70470-0833
US

V. Phone/Fax

Practice location:
  • Phone: 985-635-6943
  • Fax: 985-635-6948
Mailing address:
  • Phone: 985-273-3159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number08846R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: