Provider Demographics
NPI:1417951187
Name:BAKER, JOAN M (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608B AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8210
Mailing Address - Country:US
Mailing Address - Phone:252-520-0020
Mailing Address - Fax:252-520-0040
Practice Address - Street 1:608B AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8210
Practice Address - Country:US
Practice Address - Phone:252-520-0020
Practice Address - Fax:252-520-0040
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24572207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913185Medicaid
NC8913185Medicaid
203257BMedicare PIN