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General NPI Number Information
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NPI Number | 1497799415
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Entity Type | Individual
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Provider Name | ELMO WILLIAM BALDASSARI DPM
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 1439 MONROE AVE STE 3
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City | DUNMORE
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State | PA
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Zip | 18509-2497
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Country | US
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Telephone | 570-963-1974
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Fax | 570-963-0762
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Provider Business Mailing Address
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Address Line | 1439 MONROE AVE STE 3
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City | DUNMORE
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State | PA
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Zip | 18509-2497
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Country | US
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Telephone | 570-963-1974
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Fax | 570-963-0762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC003666L
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License Number State | PA
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