Provider Demographics
NPI:1093756207
Name:BAKER, THOMAS MURRAY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MURRAY
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 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-781-6758
Mailing Address - Fax:814-781-3317
Practice Address - Street 1:1100 MILLION DOLLAR HWY
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-2728
Practice Address - Country:US
Practice Address - Phone:814-781-6758
Practice Address - Fax:814-781-3317
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG58944Medicaid
GA326246167AMedicaid
PA102489913Medicaid
WIH26591Medicare UPIN
GA326246167AMedicaid
SCG58944Medicaid