Provider Demographics
NPI:1356349914
Name:BAKER, MATTHEW G (PA-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:G
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE 5202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3485
Mailing Address - Country:US
Mailing Address - Phone:704-547-1495
Mailing Address - Fax:704-547-1861
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 5202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-547-1495
Practice Address - Fax:704-547-1861
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03915363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL0111OtherJOHN DEERE PROV #
ILP00108973OtherRR MEDICARE PROV #
IL713460OtherHEALTHLINK PROV #
IL092552OtherHEALTH ALLIANCE PROV #
NC1356349914Medicaid
NCNCC272AMedicare PIN
IL713460OtherHEALTHLINK PROV #