1346454881 NPI number — AMANDA MARIE BAKER MD

Table of content: CRISTEN SUTTON APRN (NPI 1356018923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346454881 NPI number — AMANDA MARIE BAKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
AMANDA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FROMENT
Provider Other First Name:
AMANDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346454881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 WALT WHITMAN RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-873-9533
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4420 LAKE BOONE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-7505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-784-3034
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007

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: 207L00000X , with the licence number:  200401209 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346454881 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q0120E , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810009477 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147CE . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201079 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5906909 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9905110 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 810618 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com