Provider Demographics
NPI:1548203565
Name:BAKER, DOUGLAS E (CRNA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:BAKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:STE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:147 GETTYS ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2534
Practice Address - Country:US
Practice Address - Phone:717-337-4168
Practice Address - Fax:717-337-4318
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN509560L367500000X
MDR146720367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101006OtherGEISINGER
PA1416545OtherHIGHMARK BLUE SHIELD-GH
PA20031166OtherAMERIHEALTH MERCY GH
PA101820579Medicaid
PA430075168OtherRAILROAD MCR GH
PA2103042000OtherAMERIHEALTH 65PA GH
PA50067117OtherCAPITAL BLUE CROSS
PA1546143OtherGATEWAY-WMG
PA50067117OtherCAPITAL BLUE CROSS
PA060943GVQMedicare PIN