Provider Demographics
NPI: | 1194958918 |
---|---|
Name: | DRS. BALDWIN, HORNBAKE AND SPAGNOLA PC |
Entity type: | Organization |
Organization Name: | DRS. BALDWIN, HORNBAKE AND SPAGNOLA PC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | EARL |
Authorized Official - Middle Name: | RODNEY |
Authorized Official - Last Name: | HORNBAKE |
Authorized Official - Suffix: | III |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 860-767-0145 |
Mailing Address - Street 1: | 10 WILDWOOD MEDICAL CENTER |
Mailing Address - Street 2: | |
Mailing Address - City: | ESSEX |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06426-1154 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 860-767-0145 |
Mailing Address - Fax: | 860-767-0021 |
Practice Address - Street 1: | 10 WILDWOOD MEDICAL CTR |
Practice Address - Street 2: | |
Practice Address - City: | ESSEX |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06426-1154 |
Practice Address - Country: | US |
Practice Address - Phone: | 860-767-0145 |
Practice Address - Fax: | 860-767-0021 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-08-27 |
Last Update Date: | 2009-08-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty |