Provider Demographics
NPI:1053639484
Name:BAKER, KEVIN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SCOTT
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:STONY BROOK MEDICINE HSC LEVEL 4 RM 120
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8460
Mailing Address - Country:US
Mailing Address - Phone:631-444-5400
Mailing Address - Fax:631-444-7538
Practice Address - Street 1:HSC LEVEL 4 RM 120
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8460
Practice Address - Country:US
Practice Address - Phone:631-444-5400
Practice Address - Fax:631-444-7538
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2774752085R0202X
390200000X
KY562822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program