Provider Demographics
NPI:1922635705
Name:BAER, CARLTON PHILIP
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:PHILIP
Last Name:BAER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MASONIC DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2115
Mailing Address - Country:US
Mailing Address - Phone:571-361-9084
Mailing Address - Fax:
Practice Address - Street 1:99 MASONIC DR STE 101
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2573
Practice Address - Country:US
Practice Address - Phone:717-689-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD469413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine