Healthcare Provider Details

I. General information

NPI: 1881937712
Provider Name (Legal Business Name): MEREDITH BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST STE 400
PORTLAND ME
04102-3163
US

IV. Provider business mailing address

887 CONGRESS ST STE 400
PORTLAND ME
04102-3163
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-5555
  • Fax:
Mailing address:
  • Phone: 207-662-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number256066
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD25775
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: