Provider Demographics
NPI:1215995162
Name:BALDASARO, MATHEW H (DO)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:H
Last Name:BALDASARO
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 1:237 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1863
Mailing Address - Country:US
Mailing Address - Phone:508-394-2116
Mailing Address - Fax:508-760-1919
Practice Address - Street 1:237 STATION AVE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1863
Practice Address - Country:US
Practice Address - Phone:508-394-2116
Practice Address - Fax:508-760-1919
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227406208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics