Provider Demographics
NPI:1861433377
Name:BALDERAMA, HERMINIO B (MD)
Entity type:Individual
Prefix:DR
First Name:HERMINIO
Middle Name:B
Last Name:BALDERAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8357 MEMPHIS ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2138
Mailing Address - Country:US
Mailing Address - Phone:901-371-0200
Mailing Address - Fax:901-383-1178
Practice Address - Street 1:8357 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2138
Practice Address - Country:US
Practice Address - Phone:901-371-0200
Practice Address - Fax:901-383-1178
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD020213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051841Medicaid
TN3051841Medicaid
TNE51183Medicare UPIN