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General NPI Number Information
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NPI Number | 1558517078
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Entity Type | Individual
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Provider Name | KRISTIN SARAH BALTAZAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 200 NORTH ST SUITE 304
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City | GENEVA
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State | NY
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Zip | 14456-1561
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Country | US
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Telephone | 315-787-5383
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Fax |
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Provider Business Mailing Address
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Address Line | 6336 CANDLE LIGHT RUN
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City | VICTOR
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State | NY
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Zip | 14564-9592
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 60 261346
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License Number State | NY
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