MEDICARE: LORI A BAXTER M.D., FAAP

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	208000000X	Pediatrics Physician	MD21610	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MD21610	OTHER	TN	MEDICAL LICESNE NUMBER

General Provider Information

NPI Number	:	1669416921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI A BAXTER M.D., FAAP

Provider Business Mailing Address
First Line	:	CEDAR CREEK PEDIATRIC & ADOLESCENT MEDICINE, PC
Second Line	:	616 SMITHVIEW DRIVE
City	:	MARYVILLE
State	:	TN
Zip	:	37803-2100
Country	:	US
Telephone Number	:	865-379-2277
Fax Number	:	865-738-0087

Provider Business Practice Location Address
First Line	:	CEDAR CREEK PEDIATRIC & ADOLESCENT MEDICINE, PC
Second Line	:	616 SMITHVIEW DRIVE
City	:	MARYVILLE
State	:	TN
Zip	:	37803-6100
Country	:	US
Telephone Number	:	865-379-2277
Fax Number	:	865-738-0087

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	03/07/2023

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