Provider Demographics
NPI:1144428541
Name:BAKER, CRYSTAL M (RPA-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:M
Other - Last Name:TRYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:99 EAST STATE STREET
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-0010
Mailing Address - Country:US
Mailing Address - Phone:518-775-4201
Mailing Address - Fax:518-775-4225
Practice Address - Street 1:99 EAST STATE STREET
Practice Address - Street 2:MAB SUITE G01
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-0010
Practice Address - Country:US
Practice Address - Phone:518-775-4201
Practice Address - Fax:518-775-4225
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011908363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400144389Medicare PIN