MEDICARE: CHANEL JUTRISTE BAKER

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	332U00000X	Home Delivered Meals		MD

General Provider Information

NPI Number	:	1578419693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANEL JUTRISTE BAKER

Provider Business Mailing Address
First Line	:	46 CABLE HOLLOW WAY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1020
Country	:	US
Telephone Number	:	240-726-3391
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 CABLE HOLLOW WAY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1020
Country	:	US
Telephone Number	:	240-726-3391
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “ CHANEL JUTRISTE BAKER ” Practice Location

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