Provider Demographics
NPI:1760423339
Name:BAKER, JOHN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
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 1:600 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5704
Mailing Address - Country:US
Mailing Address - Phone:864-512-2000
Mailing Address - Fax:864-512-8492
Practice Address - Street 1:600 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5704
Practice Address - Country:US
Practice Address - Phone:864-512-2000
Practice Address - Fax:864-512-8492
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12896207Q00000X
HI13844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC128962Medicaid
S376900OtherRAILROAD MEDICARE
GA080112826OtherMEDICAID
SCP01487648OtherRR MEDICARE
SC12896Medicaid
GA080112826OtherMEDICAID
SC128962Medicaid
SCSC35807842Medicare PIN
SC7098Medicare PIN
SCD90533Medicare UPIN
D90533Medicare UPIN
SC12896Medicaid