Healthcare Provider Details

I. General information

NPI: 1396787438
Provider Name (Legal Business Name): WILLIAM BALDINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CREE DR STE A
LOCK HAVEN PA
17745-2639
US

IV. Provider business mailing address

147 SUMMERS POINT DR #135A-501
MILL HALL PA
17751-8527
US

V. Phone/Fax

Practice location:
  • Phone: 570-893-5191
  • Fax: 570-893-5333
Mailing address:
  • Phone: 973-713-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD017458E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: