Provider Demographics
NPI:1205929155
Name:BAKER, GREGORY L (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:BAKER
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:
Practice Address - Street 1:613 23RD ST STE 420
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2885
Practice Address - Country:US
Practice Address - Phone:606-325-8561
Practice Address - Fax:606-325-3591
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33745207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64373459Medicaid
OH2108918Medicaid
KYP00885633OtherRR MEDICARE
WV0100936000Medicaid
WV0100936000Medicaid
KYG72787Medicare UPIN
OH2108918Medicaid
KY64373459Medicaid