Provider Demographics
NPI:1356308134
Name:BAKER, CHARLES EDWIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWIN
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:E
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:CROSSNORE
Mailing Address - State:NC
Mailing Address - Zip Code:28616
Mailing Address - Country:US
Mailing Address - Phone:828-737-7711
Mailing Address - Fax:828-737-7713
Practice Address - Street 1:436 HOSPITAL DR
Practice Address - Street 2:STE 230
Practice Address - City:LINVILLE
Practice Address - State:NC
Practice Address - Zip Code:28646
Practice Address - Country:US
Practice Address - Phone:828-737-7711
Practice Address - Fax:828-737-7713
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912697Medicaid
NC12697OtherBCBS
NC12697OtherBCBS
NC202119BMedicare PIN