1508954835 NPI number — JOHN D BAXTER MD

Table of content: JOHN D BAXTER MD (NPI 1508954835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508954835 NPI number — JOHN D BAXTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAXTER
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508954835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FEDERAL ST STE SW200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-356-4924
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 COOPER PLZ
Provider Second Line Business Practice Location Address:
SUITE 513
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-963-3715
Provider Business Practice Location Address Fax Number:
856-635-1052
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  MD037108E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: MA53210 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023745 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3182437 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84027 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14278 . This is a "UNIVERSITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 146258 . This is a "PENNSYLVANIA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: P437737 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110084235 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 146258 . This is a "MAREIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K6105 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123460 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0083872000 . This is a "AMERIHEALTH, HMO, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010003720 00 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1243147 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4608402 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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