Basic Information
| Provider Information | |||||||||
| NPI: | 1396005328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALDWIN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 97 CORNERSTONE DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275198403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194600993 | ||||||||
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| Practice Location | |||||||||
| Address1: | 97 CORNERSTONE DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275198403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194600993 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2012 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 201500200 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1396005328 | 05 | NC | MEDICAID |