Provider Demographics
NPI:1033192745
Name:BAKER, GENE BENJAMIN (PA)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:BENJAMIN
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 LAKESIDE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6806
Mailing Address - Country:US
Mailing Address - Phone:434-385-4184
Mailing Address - Fax:434-385-8616
Practice Address - Street 1:2137 LAKESIDE DR
Practice Address - Street 2:STE 100
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6806
Practice Address - Country:US
Practice Address - Phone:434-385-4184
Practice Address - Fax:434-385-8616
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
008344C68OtherMEDICARE PROVIDER NUMBER PRIOR TO 09/01/07
VA010179301Medicaid
VA1528155892OtherCVFP CORPORATR NPI
CA2436OtherMEDICARE RAILROAD GROUP NUMBER
P00370488OtherMEDICARE RAILROAD PROVIDER NUMBER
VA1528155892Medicaid
VA1972680049OtherCVFP SITE NPI
VACO3658OtherMEDICARE GROUP PTAN
C08183OtherMEDICARE GROUP NUMBER PRIOR TO 09/01/07
P00370488OtherMEDICARE RAILROAD PROVIDER NUMBER
VA1972680049OtherCVFP SITE NPI
VAP86884Medicare UPIN