MEDICARE: LIDIA C BALDEA 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	207R00000X	Internal Medicine Physician	27049	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952321341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDIA C BALDEA MD

Provider Business Mailing Address
First Line	:	PO BOX 743294
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3294
Country	:	US
Telephone Number	:	864-365-0020
Fax Number	:	864-365-0205

Provider Business Practice Location Address
First Line	:	10 ENTERPRISE BLVD STE 111
Second Line	:	COVENANT INTERNAL MEDICINE
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3534
Country	:	US
Telephone Number	:	864-365-0200
Fax Number	:	864-365-0205

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/28/2016

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Directions to “ LIDIA C BALDEA MD” Practice Location

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