Provider Demographics
NPI:1952484370
Name:BAKER, ROBERT DENIO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DENIO
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 1:4511 HARLEM ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3822
Mailing Address - Country:US
Mailing Address - Phone:716-878-6720
Mailing Address - Fax:716-878-6740
Practice Address - Street 1:219 BRYANT STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7793
Practice Address - Fax:716-888-3842
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1189202080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000526157001OtherBC/BS
PA0018168400001Medicaid
5111041OtherIHA
NY02090408Medicaid
040426002259OtherFIDELIS
00025108901OtherUNIVERA
CC4801Medicare UPIN
C46266Medicare UPIN
NY02090408Medicaid