Provider Demographics
NPI:1760616817
Name:BAKER, MATTHEW LECARPENTIER (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LECARPENTIER
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 1:223 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4202
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:217 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1823
Practice Address - Country:US
Practice Address - Phone:859-236-3726
Practice Address - Fax:859-236-3019
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47076207LP2900X, 207L00000X
NC2013-01259207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5996966OtherAETNA
NC1760616817Medicaid
NC179RKOtherBCBS
NC275928OtherMEDCOST
KY7100293780Medicaid
NC1760616817OtherVIRGINIA MEDICAID
NC1760616817OtherTRICARE
KY000001136574OtherANTHEM PROVIDER ID
NCP01270450OtherRAILROAD MEDICARE
NC1760616817OtherPARTNERS
NC3650736OtherUNITED HEALTHCARE