Provider Demographics
NPI:1851577225
Name:CHARLES E BAKER MD PA
Entity Type:Organization
Organization Name:CHARLES E BAKER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:828-737-7711
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:CROSSNORE
Mailing Address - State:NC
Mailing Address - Zip Code:28616-0130
Mailing Address - Country:US
Mailing Address - Phone:828-737-7711
Mailing Address - Fax:828-737-7713
Practice Address - Street 1:436 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:LINVILLE
Practice Address - State:NC
Practice Address - Zip Code:28646-0767
Practice Address - Country:US
Practice Address - Phone:828-737-7711
Practice Address - Fax:828-737-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912697Medicaid
NC8912697Medicaid