Provider Demographics
NPI:1912902123
Name:BAKER, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1265 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9478
Mailing Address - Country:US
Mailing Address - Phone:304-388-7782
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:223 MAPLEWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24790
Practice Address - Country:US
Practice Address - Phone:304-645-2700
Practice Address - Fax:304-645-3188
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2016-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV16231207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0073161000Medicaid
BA0678816Medicare PIN
E065888Medicare UPIN
WV0073161000Medicaid
BA0678814Medicare PIN
110149084Medicare PIN