Provider Demographics
NPI:1235130147
Name:BAKER, GEORGE WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:BAKER
Suffix:JR
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 1:130 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-9503
Mailing Address - Country:US
Mailing Address - Phone:717-352-7881
Mailing Address - Fax:717-352-8850
Practice Address - Street 1:130 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17222-9503
Practice Address - Country:US
Practice Address - Phone:717-352-7881
Practice Address - Fax:717-352-8850
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010038E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009920480002Medicaid
C27407Medicare UPIN
PA018114Medicare PIN