Provider Demographics
NPI:1407930068
Name:BAKER, KENNETH JOHN (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
Last Name:BAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO 418
Mailing Address - Street 2:
Mailing Address - City:NORRIDGEWOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04957-0418
Mailing Address - Country:US
Mailing Address - Phone:207-634-3285
Mailing Address - Fax:207-634-4009
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORRIDGEWOCK
Practice Address - State:ME
Practice Address - Zip Code:04957-0418
Practice Address - Country:US
Practice Address - Phone:207-634-3285
Practice Address - Fax:207-634-4009
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME970208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000213020Medicaid
ME000213020Medicaid
ME008566Medicare ID - Type Unspecified