Provider Demographics
NPI:1295373785
Name:BAKER, JEREMY RONALD (PA)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:RONALD
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:189 KEARSARGE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMOT
Mailing Address - State:NH
Mailing Address - Zip Code:03287-4706
Mailing Address - Country:US
Mailing Address - Phone:603-359-8107
Mailing Address - Fax:
Practice Address - Street 1:19 WOODLAND ST STE 23
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2368
Practice Address - Country:US
Practice Address - Phone:860-522-2251
Practice Address - Fax:860-493-2552
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2022-05-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty