Healthcare Provider Details

I. General information

NPI: 1942261631
Provider Name (Legal Business Name): REGINALD LAMONT BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 ARLINGTON BLVD SUITE 400
FAIRFAX VA
22031-4621
US

IV. Provider business mailing address

2722 MERRILEE DR STE 230
FAIRFAX VA
22031-4400
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-4444
  • Fax: 703-204-0116
Mailing address:
  • Phone: 703-698-4444
  • Fax: 703-204-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number0101223831
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME98093
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME98093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: