Provider Demographics
NPI:1033119003
Name:BAKER, ALVA S III (MD)
Entity Type:Individual
Prefix:
First Name:ALVA
Middle Name:S
Last Name:BAKER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 OBRECHT RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7650
Mailing Address - Country:US
Mailing Address - Phone:410-795-8808
Mailing Address - Fax:410-552-0344
Practice Address - Street 1:710 OBRECHT RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7650
Practice Address - Country:US
Practice Address - Phone:410-795-8808
Practice Address - Fax:410-552-0344
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDO8258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4124316OOMedicaid
MDT8620002OtherBCBS
D74557Medicare UPIN
MD4124316OOMedicaid