Healthcare Provider Details

I. General information

NPI: 1902942808
Provider Name (Legal Business Name): BRIAN RUSSELL BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E MONUMENT ST SUITE 6-100
BALTIMORE MD
21287-0020
US

IV. Provider business mailing address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3380
  • Fax:
Mailing address:
  • Phone: 443-481-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101240565
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD70275
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: