MEDICARE: ROSEMARY BALDERSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101036372	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	541595397	OTHER	VA	PRIVATE HEALTHCARE SYSTEM
2	541595397	OTHER	VA	MID ATLANTIC SOLUTIONS
3	30107	OTHER	VA	SENTARA/OPTIMA
4	541595397	OTHER	VA	VIRGINIA HEALTH NETWORK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	454283	OTHER	VA	ANTHEM
7	541595397	OTHER	VA	CIGNA
8	7720440	OTHER	VA	AETNA
9	541595397	OTHER	VA	TRICARE

General Provider Information

NPI Number	:	1235102120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY BALDERSTON MD

Provider Business Mailing Address
First Line	:	3241 WESTERN BRANCH BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5260
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	1024 BATTLEFIELD BLVD S
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-4215
Country	:	US
Telephone Number	:	757-410-4488
Fax Number	:	757-410-4450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	04/09/2010

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Directions to “ ROSEMARY BALDERSTON MD” Practice Location

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