Provider Demographics
NPI:1023122678
Name:BAKER, MEGAN KEEFFE (MD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KEEFFE
Last Name:BAKER
Suffix:
Gender:F
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:PO BOX 751469
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:3510 N HIGHWAY 17
Practice Address - Street 2:SUITE 325
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8227
Practice Address - Country:US
Practice Address - Phone:843-606-7020
Practice Address - Fax:843-606-7019
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26122208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC261228Medicaid
SCL29792Medicare UPIN