Provider Demographics
NPI:1679545149
Name:BALDIZZI, ANTHONY (M D)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BALDIZZI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 66TH ST N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4949
Mailing Address - Country:US
Mailing Address - Phone:727-623-9100
Mailing Address - Fax:727-623-9103
Practice Address - Street 1:3901 66TH ST N
Practice Address - Street 2:SUITE 102
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4949
Practice Address - Country:US
Practice Address - Phone:727-623-9100
Practice Address - Fax:727-623-9103
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0067000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F90807Medicare UPIN
FL26216ZMedicare ID - Type Unspecified