MEDICARE: NICHOLAS JOEL BAKER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	01211	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P00670282	OTHER		RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FQ1211	OTHER	WV	HEALTH PLAN
2	#145072	OTHER	WV	CARELINK
3	01211	OTHER	WV	WV LICENSE
4	001967359	OTHER	WV	MT. STATE BC/BS PAY TO #
5	#001948536	OTHER	WV	MT. STATE BC/BS SERVICE N
6	001804181	OTHER	WV	MT. STATE BC/BS PAY TO #
7	55-0695143	OTHER	WV	HEALTH PARTNERS NETWORK

General Provider Information

NPI Number	:	1225177504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JOEL BAKER PA-C

Provider Business Mailing Address
First Line	:	4 NORTHRIDGE DR STE 118
Second Line	:
City	:	BUCKHANNON
State	:	WV
Zip	:	26201-8484
Country	:	US
Telephone Number	:	304-473-1440
Fax Number	:	304-473-1441

Provider Business Practice Location Address
First Line	:	4 NORTHRIDGE DR STE 118
Second Line	:
City	:	BUCKHANNON
State	:	WV
Zip	:	26201-8484
Country	:	US
Telephone Number	:	304-473-1440
Fax Number	:	304-473-1441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	10/17/2022

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Directions to “ NICHOLAS JOEL BAKER PA-C” Practice Location

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