Provider Demographics
NPI:1558364273
Name:BAXTER, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BAXTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:229 MEDWAY ST
Mailing Address - Street 2:APT 301
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5300
Mailing Address - Country:US
Mailing Address - Phone:401-751-4633
Mailing Address - Fax:
Practice Address - Street 1:38 HAMLET AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4423
Practice Address - Country:US
Practice Address - Phone:401-762-0020
Practice Address - Fax:401-762-1819
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD039132085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI003913OtherTUFTS TGR
RI1198-5OtherBCBS TGR OFFICE
RI7008831Medicaid
RI7111640OtherAETNA TGR OFFICE
MA0193551Medicaid
RI1570-5OtherTGR KENT
RI2203OtherNHP TGR
MA27045OtherMA LICENSE
RI16-00137OtherUHC
RIP00180550OtherBCBS TGR
RI408889OtherBLUE CHIP TGR
RI756624OtherCONNECTICARE TGR
RIMD03913OtherRI LICENSE
RIP00180550OtherBCBS TGR