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Individual

DR. ELMO WILLIAM BALDASSARI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
1439 MONROE AVE STE 3, DUNMORE, PA 18509-2497
(570) 963-1974
(570) 963-0762
Mailing address
1439 MONROE AVE STE 3, DUNMORE, PA 18509-2497
(570) 963-1974
(570) 963-0762

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC003666L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0016528000002
PA
01
480024264
RAILROAD MEDICARE
PA
Enumeration date
06/16/2006
Last updated
04/17/2019
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