Provider Demographics
NPI:1134365711
Name:BAKER, BARRIE (MD)
Entity type:Individual
Prefix:DR
First Name:BARRIE
Middle Name:
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 1:700 BLOOMFIELD AVE # 550
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2497
Mailing Address - Country:US
Mailing Address - Phone:215-669-2106
Mailing Address - Fax:
Practice Address - Street 1:700 BLOOMFIELD AVE # 550
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2497
Practice Address - Country:US
Practice Address - Phone:215-669-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-01
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052497L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV18679OtherSTATE MEDICAL LICENSE
NY297357OtherSTATE MEDICAL LICENSE
PAMD052497LOtherSTATE LICENSE
RIMD15226OtherSTATE LICENSE
NJ25MA10590100OtherSTATE MEDICAL LICENSE
MA261558OtherBOARD OF REGISTRATION OF MASSACHUSETTS