Basic Information
| Provider Information | |||||||||
| NPI: | 1366862260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALDWIN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN,CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W SEVENTH ST | ||||||||
| Address2: | FREDERICK REGIONAL HEALTH SYSTEM | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405663300 | ||||||||
| FaxNumber: | 2405663895 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 BUCKEYSTOWN PIKE | ||||||||
| Address2: | FMH WELLNESS CENTER | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217038331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403796010 | ||||||||
| FaxNumber: | 2403796040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2014 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | N | Other Service Providers | Health Educator | 163WD0400X | R085828 | MD | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.