1235102120 NPI number — ROSEMARY BALDERSTON MD

Table of content: (NPI 1003270034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235102120 NPI number — ROSEMARY BALDERSTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDERSTON
Provider First Name:
ROSEMARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235102120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3241 WESTERN BRANCH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23321-5260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-686-3508
Provider Business Mailing Address Fax Number:
757-686-0541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1024 BATTLEFIELD BLVD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23322-4215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-410-4488
Provider Business Practice Location Address Fax Number:
757-410-4450
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101036372 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 541595397 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541595397 . This is a "MID ATLANTIC SOLUTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 30107 . This is a "SENTARA/OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541595397 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005643767 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 454283 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541595397 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7720440 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541595397 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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