MEDICARE: DR. MARY-THERESA LEVENTHAL BAKER M.D.

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	2080C0008X	Child Abuse Pediatrics Physician	MD2013-0585	NM
2	208000000X	Pediatrics Physician	D0039907	MD

General Provider Information

NPI Number	:	1508002981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY-THERESA LEVENTHAL BAKER M.D.

Provider Business Mailing Address
First Line	:	625 SILVER AVE SW
Second Line	:	2ND FLOOR
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3123
Country	:	US
Telephone Number	:	505-272-6849
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 SILVER AVE SW
Second Line	:	2ND FLOOR
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3123
Country	:	US
Telephone Number	:	505-272-6849
Fax Number	:

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

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	10/08/2013

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