Provider Demographics
NPI:1013016096
Name:BALDWIN, MICHAEL SCOTT (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MILES CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4067
Mailing Address - Country:US
Mailing Address - Phone:207-563-1040
Mailing Address - Fax:207-810-2412
Practice Address - Street 1:24 MILES CENTER WAY
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4067
Practice Address - Country:US
Practice Address - Phone:207-563-1040
Practice Address - Fax:207-810-2412
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001130363A00000X
CA59642363A00000X
MEPA439363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00615740OtherRAILROAD MEDICARE
VAC06695OtherGROUP PTAN
VA1013016096Medicaid
VAC06778OtherGROUP PTAN
VAP00615740OtherRAILROAD MEDICARE
VAC06695OtherGROUP PTAN
P01461Medicare UPIN
009902T64Medicare ID - Type Unspecified