Provider Demographics
NPI:1427232131
Name:ERIC J. BAKER, M.D., P.A.
Entity Type:Organization
Organization Name:ERIC J. BAKER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:864-234-7744
Mailing Address - Street 1:26 ROPER CORNERS CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4833
Mailing Address - Country:US
Mailing Address - Phone:864-234-7744
Mailing Address - Fax:
Practice Address - Street 1:26 ROPER CORNERS CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4833
Practice Address - Country:US
Practice Address - Phone:864-234-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14818207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX ID NUMBER
SC3702Medicare PIN
SC=========OtherTAX ID NUMBER