Provider Demographics
NPI:1407805666
Name:BAKER, RONALD W SR (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:BAKER
Suffix:SR
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 1:1250 SCENIC HWY STE 1701-244
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6359
Mailing Address - Country:US
Mailing Address - Phone:315-529-5251
Mailing Address - Fax:
Practice Address - Street 1:1250 SCENIC HWY STE 1701-244
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6359
Practice Address - Country:US
Practice Address - Phone:315-529-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82939207P00000X, 207X00000X
TN45554207X00000X, 207XX0005X
NY226116207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02338223Medicaid
TN1517073Medicaid
NYDD2757Medicare ID - Type Unspecified
NYH72189Medicare UPIN
NY02338223Medicaid