Provider Demographics
NPI:1043294663
Name:BAKER, JOHN R (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11314
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-312-3135
Practice Address - Street 1:300 MEDICAL PKWY STE 212
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-312-5292
Practice Address - Fax:757-609-3225
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4241732084V0102X
VA01012494632084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010588770001Medicaid
PA081874R3PMedicare ID - Type Unspecified
PA081874FKCMedicare PIN
PA1010588770001Medicaid