MEDICARE: DR. SHAUN BALDWIN DPT

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	225100000X	Physical Therapist	25391	MD

General Provider Information

NPI Number	:	1285026120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUN BALDWIN DPT

Provider Business Mailing Address
First Line	:	350 NEW FIDELITY CT
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-2665
Country	:	US
Telephone Number	:	919-258-2714
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	2219 BEL PRE RD
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-2204
Country	:	US
Telephone Number	:	443-566-4255
Fax Number	:	443-566-4234

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

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	09/13/2018

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