Provider Demographics
NPI:1922078948
Name:BAKER, KYLE A (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:A
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 1:1 GROVE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-4116
Mailing Address - Country:US
Mailing Address - Phone:860-224-2447
Mailing Address - Fax:860-826-5845
Practice Address - Street 1:1 GROVE ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053
Practice Address - Country:US
Practice Address - Phone:860-224-2447
Practice Address - Fax:860-826-5845
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001312298Medicaid
CT160001225Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID
CT001312298Medicaid