MEDICARE: DR. GERARDO BALDASSARRI M.D.

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	ME92921	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16636	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1275504581	OTHER	FL	TRICARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275504581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARDO BALDASSARRI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 746636
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6636
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	98 NOCATEE VILLAGE DR
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-6152
Country	:	US
Telephone Number	:	904-202-4243
Fax Number	:	904-202-4639

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	01/10/2023

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