Provider Demographics
NPI:1760450910
Name:NEWPORT FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:NEWPORT FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-368-5747
Mailing Address - Street 1:PO BOX J
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953
Mailing Address - Country:US
Mailing Address - Phone:207-368-5747
Mailing Address - Fax:207-368-5483
Practice Address - Street 1:26 MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953
Practice Address - Country:US
Practice Address - Phone:207-368-5747
Practice Address - Fax:207-368-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15273Medicare ID - Type Unspecified
203857Medicare ID - Type Unspecified