Provider Demographics
NPI:1447224241
Name:BAKER, KATHRYN A (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3506
Mailing Address - Country:US
Mailing Address - Phone:203-371-8790
Mailing Address - Fax:203-373-0463
Practice Address - Street 1:4141 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3506
Practice Address - Country:US
Practice Address - Phone:203-371-8790
Practice Address - Fax:203-373-0463
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039274208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT040039274CT01OtherBLUE CROSS OF CT
CT7505300OtherAETNA HEALTH PLANS
CT2492148OtherUNITEDHEALTHCARE
CT713945OtherCONNECTICARE
CT1447224241Medicaid
CT6253862OtherCIGNA
CAP2654371OtherOXFORD PROVIDER #