Healthcare Provider Details

I. General information

NPI: 1235130147
Provider Name (Legal Business Name): GEORGE WILLIAM BAKER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E MAIN ST
FAYETTEVILLE PA
17222-9503
US

IV. Provider business mailing address

130 E MAIN ST
FAYETTEVILLE PA
17222-9503
US

V. Phone/Fax

Practice location:
  • Phone: 717-352-7881
  • Fax: 717-352-8850
Mailing address:
  • Phone: 717-352-7881
  • Fax: 717-352-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD010038E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: