Provider Demographics
NPI:1801876032
Name:BALDINO, VINCENT E (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:E
Last Name:BALDINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W RITNER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4324
Mailing Address - Country:US
Mailing Address - Phone:215-336-2145
Mailing Address - Fax:215-336-5732
Practice Address - Street 1:1701 W RITNER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4324
Practice Address - Country:US
Practice Address - Phone:215-336-2145
Practice Address - Fax:215-336-5732
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003706L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0588052Medicaid
PAB36395Medicare UPIN
PA0588052Medicaid