Healthcare Provider Details

I. General information

NPI: 1356541965
Provider Name (Legal Business Name): KEVIN J BALDOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR STE 202
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

8081 INNOVATION PARK DR STE 202
FAIRFAX VA
22031-4867
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-7050
  • Fax: 571-472-7001
Mailing address:
  • Phone: 571-472-7050
  • Fax: 571-472-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101242023
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: