Provider Demographics
NPI:1275540692
Name:BAKER, MATTHEW BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRYAN
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 1:1205 TWO ISLAND CT.
Mailing Address - Street 2:#203
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7406
Mailing Address - Country:US
Mailing Address - Phone:843-971-2860
Mailing Address - Fax:303-278-4841
Practice Address - Street 1:1205 TWO ISLAND CT.
Practice Address - Street 2:#203
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7406
Practice Address - Country:US
Practice Address - Phone:843-971-2860
Practice Address - Fax:303-278-4841
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43027208200000X
SCMD87844208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803906OtherMEDICARE GROUP PIN
CO83381872Medicaid
CO803906OtherMEDICARE GROUP PIN
COC803907Medicare PIN