Provider Demographics
NPI:1467778407
Name:BAKER, RALPH L SR
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:L
Last Name:BAKER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4349
Mailing Address - Country:US
Mailing Address - Phone:704-636-1850
Mailing Address - Fax:704-637-7120
Practice Address - Street 1:428 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4349
Practice Address - Country:US
Practice Address - Phone:704-636-1850
Practice Address - Fax:704-637-7120
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
NC222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795448Medicaid