Healthcare Provider Details

I. General information

NPI: 1821542564
Provider Name (Legal Business Name): KATELYN M BAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN M STRITTMATHER PA-C

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 MARVEL CT
EASTON MD
21601
US

IV. Provider business mailing address

403 MARVEL CT
EASTON MD
21601-4053
US

V. Phone/Fax

Practice location:
  • Phone: 410-819-8867
  • Fax: 410-819-8873
Mailing address:
  • Phone: 410-819-8867
  • Fax: 410-819-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0006738
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10002090A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: