Provider Demographics
NPI:1831138452
Name:BAKER, PAUL BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRUCE
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 1:2200 WILSON BLVD
Mailing Address - Street 2:#102-227
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3397
Mailing Address - Country:US
Mailing Address - Phone:301-754-7503
Mailing Address - Fax:
Practice Address - Street 1:575 MAIN ST
Practice Address - Street 2:SUITE 253
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4343
Practice Address - Country:US
Practice Address - Phone:301-498-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35112207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF60348Medicare UPIN
MD00A059S58Medicare ID - Type Unspecified
DC00A059S58Medicare PIN