Individual
THOMAS CHARLES BALDACCHINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 MEDICAL PKWY, LAKEWAY, TX 78738-1791
(512) 654-1234
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
J0437
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119193404
—
TX
01
—
8G4961
BCBS PROVIDER NUMBER
TX
Enumeration date
03/14/2006
Last updated
01/11/2022
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