Provider Demographics
NPI:1003898040
Name:BAKER, JOSEPH W (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CRYSTAL SPRING AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2462
Mailing Address - Country:US
Mailing Address - Phone:540-344-5781
Mailing Address - Fax:540-342-9308
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2462
Practice Address - Country:US
Practice Address - Phone:540-344-5781
Practice Address - Fax:540-342-9308
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037372208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010264375Medicaid
VA7364164Medicaid
VA010264375Medicaid
VA330000066Medicare ID - Type Unspecified
VA7364164Medicaid
VA017684C19Medicare PIN