Provider Demographics
NPI:1619904034
Name:BAKER, ALBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:M
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 1:3808 PEAKLAND PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2012
Mailing Address - Country:US
Mailing Address - Phone:434-384-2683
Mailing Address - Fax:
Practice Address - Street 1:2011 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1111
Practice Address - Country:US
Practice Address - Phone:434-947-3963
Practice Address - Fax:434-947-5935
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045734207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6029281Medicaid
VAF97517Medicare UPIN
VA110005597Medicare ID - Type Unspecified