Provider Demographics
NPI:1639231517
Name:BAKER, ROY P (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:P
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 1:102 KATIE CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4068
Mailing Address - Country:US
Mailing Address - Phone:864-227-2022
Mailing Address - Fax:864-227-2791
Practice Address - Street 1:102 KATIE CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4068
Practice Address - Country:US
Practice Address - Phone:864-227-2022
Practice Address - Fax:864-227-2791
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9291207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC092919Medicaid
SCD176942256Medicare PIN
SCD17694Medicare UPIN