Healthcare Provider Details

I. General information

NPI: 1962038133
Provider Name (Legal Business Name): ROBERT ANTHONY BALDINELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 WEDDINGTON MATTHEWS RD
WEDDING NC
28104
US

IV. Provider business mailing address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5326
US

V. Phone/Fax

Practice location:
  • Phone: 877-712-2735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: