Provider Demographics
NPI:1508002981
Name:BAKER, MARY-THERESA LEVENTHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY-THERESA
Middle Name:LEVENTHAL
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MESA
Other - Middle Name:LEVENTHAL
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:625 SILVER AVE SW
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3123
Mailing Address - Country:US
Mailing Address - Phone:505-272-6849
Mailing Address - Fax:
Practice Address - Street 1:625 SILVER AVE SW
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3123
Practice Address - Country:US
Practice Address - Phone:505-272-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-05852080C0008X
MDD0039907208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics