Individual
DR. JUAN DIEGO BALTODANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 WADSWORTH DR, NORTH CHESTERFIELD, VA 23236-4510
(804) 289-1131
(804) 320-3102
Mailing address
2369 STAPLES MILL RD, SUITE 200, RICHMOND, VA 23230-2909
(804) 285-8206
(804) 285-8332
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0101243367
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861665945
—
VA
Enumeration date
04/09/2008
Last updated
04/25/2013
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