1104312149 NPI number — MRS. ANNIE ELIZABETH BAKER NCC

Table of content: MRS. ANNIE ELIZABETH BAKER NCC (NPI 1104312149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104312149 NPI number — MRS. ANNIE ELIZABETH BAKER NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
ANNIE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NCC
Provider Gender Code:
F

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:
1104312149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 KING OF PRUSSIA RD FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RADNOR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19087-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-736-3739
Provider Business Mailing Address Fax Number:
610-293-7680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 WINSTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWYN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19312-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-891-7280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2018

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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