Provider Demographics
NPI:1508853821
Name:BAKER, BRAD J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:J
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BELMONT STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-752-1155
Mailing Address - Fax:508-752-4862
Practice Address - Street 1:67 BELMONT STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-752-1155
Practice Address - Fax:508-752-4862
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210064174400000X, 207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA346887OtherAETNA
MA110003432AMedicaid
MAA3273704OtherMEDICARE PTAN
MA153541OtherHARVARD PILGRIM HEALTH CA
MA210064OtherTUFTS HEALTH PLAN
MAJ23796OtherBCBS
MA6791968005OtherCIGNA
MAA3273704OtherMEDICARE PTAN
MAA32737Medicare ID - Type Unspecified