Provider Demographics
NPI:1396797833
Name:BAKER, DOLE P (MD)
Entity type:Individual
Prefix:
First Name:DOLE
Middle Name:P
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 139
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0139
Mailing Address - Country:US
Mailing Address - Phone:864-226-2822
Mailing Address - Fax:864-226-2882
Practice Address - Street 1:1206 CORNELIA RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3349
Practice Address - Country:US
Practice Address - Phone:864-226-2822
Practice Address - Fax:864-226-2882
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18104207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT19227Medicaid
SCT19227Medicaid
7018Medicare PIN