Provider Demographics
NPI:1720182413
Name:BAKER, CONSTANCE L (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 DOCTORS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6610
Mailing Address - Country:US
Mailing Address - Phone:910-343-8191
Mailing Address - Fax:910-251-8006
Practice Address - Street 1:1612 DOCTORS CIRCLE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6610
Practice Address - Country:US
Practice Address - Phone:910-343-8191
Practice Address - Fax:910-251-8006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2018481CMedicare PIN