Provider Demographics
NPI:1184780025
Name:DOLE P BAKER MD PA
Entity type:Organization
Organization Name:DOLE P BAKER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLE
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-586-2406
Mailing Address - Street 1:411 WALNUT ST
Mailing Address - Street 2:#1011
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-3443
Mailing Address - Country:US
Mailing Address - Phone:252-537-4456
Mailing Address - Fax:252-537-6168
Practice Address - Street 1:287 PREMIER BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-5076
Practice Address - Country:US
Practice Address - Phone:252-537-4456
Practice Address - Fax:252-537-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty