Healthcare Provider Details

I. General information

NPI: 1255341301
Provider Name (Legal Business Name): REMEDIOS P BALTAZAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 EASTERN BLVD
BALTIMORE MD
21221-6921
US

IV. Provider business mailing address

303 EASTERN BLVD
BALTIMORE MD
21221-6921
US

V. Phone/Fax

Practice location:
  • Phone: 410-686-2484
  • Fax: 410-686-1078
Mailing address:
  • Phone: 410-686-2484
  • Fax: 410-686-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD09082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: