Provider Demographics
NPI:1669416921
Name:BAXTER, LORI A (MD, FAAP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:CEDAR CREEK PEDIATRIC & ADOLESCENT MEDICINE, PC
Mailing Address - Street 2:616 SMITHVIEW DRIVE
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-2100
Mailing Address - Country:US
Mailing Address - Phone:865-379-2277
Mailing Address - Fax:865-738-0087
Practice Address - Street 1:CEDAR CREEK PEDIATRIC & ADOLESCENT MEDICINE, PC
Practice Address - Street 2:616 SMITHVIEW DRIVE
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6100
Practice Address - Country:US
Practice Address - Phone:865-379-2277
Practice Address - Fax:865-738-0087
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
TNMD21610208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3061228OtherMEDICAID
TNMD21610OtherMEDICAL LICESNE NUMBER
TNMD21610OtherMEDICAL LICESNE NUMBER
TNE91327Medicare UPIN