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NPI Code Detail

MEDICARE: MR. MARK ANTHONY BAXTER SR.

MEDICARE:  MR. MARK ANTHONY BAXTER SR.
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1588468110
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK ANTHONY BAXTER SR.
Provider Business Mailing Address
First Line : 3214 HOOVER AVE
Second Line :
City : DAYTON
State : OH
Zip : 45402-5320
Country : US
Telephone Number : 937-313-5782
Fax Number :
Provider Business Practice Location Address
First Line : 3214 HOOVER AVE
Second Line :
City : DAYTON
State : OH
Zip : 45402-5320
Country : US
Telephone Number : 937-313-5782
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2025
Last Update Date : 04/02/2025

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Directions to “ MR. MARK ANTHONY BAXTER SR. ” Practice Location

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