MEDICARE: SUSAN A. 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	174400000X	Specialist	A80550	CA

General Provider Information

NPI Number	:	1912901448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A. BAKER M.D.

Provider Business Mailing Address
First Line	:	436 N BEDFORD DR
Second Line	:	SUITE 211
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4310
Country	:	US
Telephone Number	:	310-274-7770
Fax Number	:	310-274-7775

Provider Business Practice Location Address
First Line	:	436 N BEDFORD DR
Second Line	:	SUITE 211
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4310
Country	:	US
Telephone Number	:	310-274-7770
Fax Number	:	310-274-7775

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/21/2011

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