Healthcare Provider Details

I. General information

NPI: 1598874547
Provider Name (Legal Business Name): VINCENT E. BALDINO D O P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W RITNER ST
PHILADELPHIA PA
19145-4324
US

IV. Provider business mailing address

1701 W RITNER ST
PHILADELPHIA PA
19145-4324
US

V. Phone/Fax

Practice location:
  • Phone: 215-336-2145
  • Fax: 215-336-5732
Mailing address:
  • Phone: 215-336-2145
  • Fax: 215-336-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS008637L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS003706L
License Number StatePA

VIII. Authorized Official

Name: DR. VINCENT E BALDINO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 215-336-2145