Provider Demographics
NPI:1972563120
Name:BAKER, RICHARD CORNELIUS (MED, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CORNELIUS
Last Name:BAKER
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 VERDANT CT.
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-266-0912
Mailing Address - Fax:
Practice Address - Street 1:420 STADIUM DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2520
Practice Address - Country:US
Practice Address - Phone:919-554-8611
Practice Address - Fax:919-554-8617
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer