Basic Information
| Provider Information | |||||||||
| NPI: | 1881695658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALDUCCI | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | KYRITSIS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KYRITSIS | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | RACHEL | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2448 HOLLY AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102954941 | ||||||||
| FaxNumber: | 4102955207 | ||||||||
| Practice Location | |||||||||
| Address1: | 2448 HOLLY AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102954941 | ||||||||
| FaxNumber: | 4102955207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 06/01/2009 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 20158 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 5536463 | 01 | MD | CCN NETWORK | OTHER | 147433401 | 01 | MD | ACS / US DEPT OF LABOR | OTHER | T6710011 | 01 | MD | BCBS OF DC | OTHER | P00247935 | 01 | MD | RAILROAD MEDICARE | OTHER | 212821 | 01 | MD | JOHNS HOPKINS HEALTHCARE | OTHER | 2228719 | 01 | MD | FIRST HEALTH NETWORK | OTHER | 624873 | 01 | MD | NATIONAL CAPITAL PPO | OTHER | 609998-08 | 01 | MD | CAREFIRST BCBS | OTHER |