Provider Demographics
NPI:1780651455
Name:BAKER, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
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: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 ST
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME260610099Medicaid
ME260610099Medicaid
008542Medicare ID - Type Unspecified