Healthcare Provider Details

I. General information

NPI: 1760238489
Provider Name (Legal Business Name): BAKER PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 MADISON AVE
TRUMBULL CT
06611-3506
US

IV. Provider business mailing address

4141 MADISON AVE
TRUMBULL CT
06611-3506
US

V. Phone/Fax

Practice location:
  • Phone: 203-371-8790
  • Fax: 203-373-0463
Mailing address:
  • Phone: 203-371-8790
  • Fax: 203-373-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHRYN A. BAKER
Title or Position: DO/OWNER
Credential: DO
Phone: 203-371-8790