Healthcare Provider Details

I. General information

NPI: 1538472824
Provider Name (Legal Business Name): MONROE GLASS BALDWIN II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 GARFIELD AVE
LYNCHBURG VA
24501-6417
US

IV. Provider business mailing address

213 WOODLAND AVE
LYNCHBURG VA
24503-4435
US

V. Phone/Fax

Practice location:
  • Phone: 434-528-5276
  • Fax: 434-525-4257
Mailing address:
  • Phone: 434-846-1447
  • Fax: 434-846-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101016823
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: