Healthcare Provider Details

I. General information

NPI: 1710544135
Provider Name (Legal Business Name): CHARLES ANTHONY BALDI III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 5TH ST SE STE 2100
PUYALLUP WA
98372-4693
US

IV. Provider business mailing address

1450 5TH ST SE STE 2100
PUYALLUP WA
98372-4693
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-3950
  • Fax: 253-864-4028
Mailing address:
  • Phone: 259-697-3950
  • Fax: 253-864-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD.MD.70016568
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: