Healthcare Provider Details

I. General information

NPI: 1154476091
Provider Name (Legal Business Name): TERRANCE L BAKER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

7027 MOUNT VISTA RD
KINGSVILLE MD
21087-1331
US

V. Phone/Fax

Practice location:
  • Phone: 410-592-9889
  • Fax: 410-592-8464
Mailing address:
  • Phone: 410-592-9889
  • Fax: 410-592-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberD0058570
License Number StateMD

VIII. Authorized Official

Name: TERRANCE LEE BAKER
Title or Position: OWNER
Credential: MD
Phone: 410-592-9889