MEDICARE: DR. GABRIELLE G BALDWIN 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	2080A0000X	Pediatric Adolescent Medicine Physician	25398	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51523265	OTHER	AL	BLUE CROSS BLUE SHIELD
2	51523267	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1528150521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELLE G BALDWIN MD

Provider Business Mailing Address
First Line	:	109 MEDICAL PARK DR
Second Line	:	SUITE B
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-5323
Country	:	US
Telephone Number	:	334-222-3555
Fax Number	:	334-222-2401

Provider Business Practice Location Address
First Line	:	109 MEDICAL PARK DR
Second Line	:	SUITE B
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-5323
Country	:	US
Telephone Number	:	334-222-3555
Fax Number	:	334-222-2401

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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