Provider Demographics
NPI:1679688956
Name:BAKER, LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1778
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1778
Mailing Address - Country:US
Mailing Address - Phone:207-375-3024
Mailing Address - Fax:207-375-3026
Practice Address - Street 1:74 LUNT ROAD SUITE 204
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105
Practice Address - Country:US
Practice Address - Phone:207-846-7666
Practice Address - Fax:207-781-4098
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO1224207Q00000X
ME1224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM2475Medicare ID - Type Unspecified
MEE45763Medicare UPIN