Provider Demographics
NPI:1497716690
Name:BAKER, BARRY O II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:O
Last Name:BAKER
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:101 COLONIAL WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2283
Mailing Address - Country:US
Mailing Address - Phone:410-658-6696
Mailing Address - Fax:410-658-4548
Practice Address - Street 1:101 COLONIAL WAY
Practice Address - Street 2:SUITE A
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2283
Practice Address - Country:US
Practice Address - Phone:410-658-6696
Practice Address - Fax:410-658-4548
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002344363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD278M374FMedicare PIN