Provider Demographics
NPI:1992700926
Name:BAEKER, THOMAS ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:BAEKER
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 1:520 TECHWOOD DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8500
Mailing Address - Country:US
Mailing Address - Phone:859-936-9844
Mailing Address - Fax:859-238-2206
Practice Address - Street 1:520 TECHWOOD DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8500
Practice Address - Country:US
Practice Address - Phone:859-236-2203
Practice Address - Fax:859-238-2206
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207RH0003X174400000X
KY28455207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY023379600OtherFEDERAL BLACK LUNG
KY110109119OtherRAILROAD MEDICARE
KY611277847OtherCHA
KY611277847OtherPREFERRED HEALTH
KY611277847OtherCIGNA
KY1066562OtherPASSPORT
KY4242445OtherAETNA
KY611277847OtherHUMANA/TRICARE
KYA13422OtherBLUEGRASS FAMILY HEALTH
KY00000051069OtherANTHEM BC/BS
KY87107OtherCOVENTRYCARES OF KENTUCKY
KY64284557Medicaid
KY0510102Medicare PIN
KY023379600OtherFEDERAL BLACK LUNG
KY4242445OtherAETNA
KY611277847OtherHUMANA/TRICARE
KY110109119OtherRAILROAD MEDICARE
KY0546604Medicare PIN
KY0783201Medicare PIN
KY0985901Medicare PIN