Provider Demographics
NPI:1790806347
Name:BAKER, MARC LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:LOUIS
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:281 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1421
Mailing Address - Country:US
Mailing Address - Phone:315-253-4459
Mailing Address - Fax:315-253-4609
Practice Address - Street 1:281 GRANT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1421
Practice Address - Country:US
Practice Address - Phone:315-253-4459
Practice Address - Fax:315-253-4609
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241055207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03237441Medicaid