Healthcare Provider Details

I. General information

NPI: 1831678705
Provider Name (Legal Business Name): HILLARY A. BAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 EDEN WAY N STE 102
CHESAPEAKE VA
23320-0745
US

IV. Provider business mailing address

808 EDEN WAY N STE 102
CHESAPEAKE VA
23320-0745
US

V. Phone/Fax

Practice location:
  • Phone: 757-216-4030
  • Fax: 757-216-4029
Mailing address:
  • Phone: 757-366-0295
  • Fax: 757-216-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006009
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: