Provider Demographics
NPI:1477638195
Name:BAKER, PAUL W JR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:600 JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:PAULSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-2413
Mailing Address - Country:US
Mailing Address - Phone:856-845-4061
Mailing Address - Fax:856-384-1770
Practice Address - Street 1:600 JESSUP RD
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-2413
Practice Address - Country:US
Practice Address - Phone:856-845-4061
Practice Address - Fax:856-384-1770
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01944000207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1196804Medicaid
NJ1196804Medicaid