Provider Demographics
NPI:1255341301
Name:BALTAZAR, REMEDIOS P (MD)
Entity type:Individual
Prefix:
First Name:REMEDIOS
Middle Name:P
Last Name:BALTAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6921
Mailing Address - Country:US
Mailing Address - Phone:410-686-2484
Mailing Address - Fax:410-686-1078
Practice Address - Street 1:303 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-6921
Practice Address - Country:US
Practice Address - Phone:410-686-2484
Practice Address - Fax:410-686-1078
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD09082208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0264610000Medicaid
D78011Medicare UPIN