Healthcare Provider Details

I. General information

NPI: 1043294663
Provider Name (Legal Business Name): JOHN R BAKER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PKWY STE 212
CHESAPEAKE VA
23320-4985
US

IV. Provider business mailing address

PO BOX 11314
BELFAST ME
04915-4004
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-5292
  • Fax: 757-609-3225
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD424173
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number0101249463
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: