Healthcare Provider Details

I. General information

NPI: 1730103953
Provider Name (Legal Business Name): MARTY ALLEN BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SUMMIT CROSSING PL SUITE 150
GASTONIA NC
28054-2137
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-5300
  • Fax: 704-671-6307
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200000009
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: