Healthcare Provider Details

I. General information

NPI: 1811014566
Provider Name (Legal Business Name): STEPHEN R BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 GEORGETOWN PIKE
GREAT FALLS VA
22066-1604
US

IV. Provider business mailing address

10800 GEORGETOWN PIKE
GREAT FALLS VA
22066-1604
US

V. Phone/Fax

Practice location:
  • Phone: 703-759-3784
  • Fax: 703-759-3784
Mailing address:
  • Phone: 703-759-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number21112
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: