Provider Demographics
NPI:1487813945
Name:BAKER, NEVIN CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:NEVIN
Middle Name:CHARLES
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 1:530 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2775
Mailing Address - Country:US
Mailing Address - Phone:724-836-1862
Mailing Address - Fax:724-689-0550
Practice Address - Street 1:530 SOUTH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2775
Practice Address - Country:US
Practice Address - Phone:724-689-1354
Practice Address - Fax:724-689-0543
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017605207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103016455Medicaid
PA416729Medicare PIN