Provider Demographics
NPI:1326257684
Name:JEFFREY H BAKER, MD, PC
Entity Type:Organization
Organization Name:JEFFREY H BAKER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HOPKINS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-867-0717
Mailing Address - Street 1:724 S ATHERTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4628
Mailing Address - Country:US
Mailing Address - Phone:814-867-0717
Mailing Address - Fax:814-867-0464
Practice Address - Street 1:724 S ATHERTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4628
Practice Address - Country:US
Practice Address - Phone:814-867-0717
Practice Address - Fax:814-867-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-029272E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC31271Medicare UPIN
PABA134298Medicare ID - Type Unspecified