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NPI Code Detail

MEDICARE: LEAH MCKINNEY BAKER PA

MEDICARE: LEAH MCKINNEY BAKER PA
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1760816953
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH MCKINNEY BAKER PA
Provider Business Mailing Address
First Line : 200 E 2ND AVE
Second Line :
City : GASTONIA
State : NC
Zip : 28052-4358
Country : US
Telephone Number : 704-874-1904
Fax Number :
Provider Business Practice Location Address
First Line : 4555 OGBURN AVE
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27105-2726
Country : US
Telephone Number : 336-703-4273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2013
Last Update Date : 03/31/2020

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Directions to “ LEAH MCKINNEY BAKER PA” Practice Location

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