Healthcare Provider Details

I. General information

NPI: 1548419419
Provider Name (Legal Business Name): KIYANDA NYREE BALDWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HOSPITAL CENTER BLVD STE 201
STAFFORD VA
22554-6203
US

IV. Provider business mailing address

2300 FALL HILL AVE STE 509
FREDERICKSBURG VA
22401-3343
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3212
  • Fax: 540-374-3224
Mailing address:
  • Phone: 540-741-2277
  • Fax: 540-741-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101252582
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101252582
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: