Provider Demographics
NPI:1174574149
Name:HALL-BAKER, EVERLYN LILEASE (MD)
Entity type:Individual
Prefix:DR
First Name:EVERLYN
Middle Name:LILEASE
Last Name:HALL-BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SARDIS RD N STE 124
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1479
Mailing Address - Country:US
Mailing Address - Phone:704-269-6127
Mailing Address - Fax:866-387-3974
Practice Address - Street 1:1805 SARDIS RD N STE 124
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1479
Practice Address - Country:US
Practice Address - Phone:704-269-6127
Practice Address - Fax:866-387-3974
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33372207Q00000X, 207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC893827EMedicaid
NC1174574149Medicaid
SC194603Medicaid
NC3827EOtherBCBSNC
NC2009351AMedicare PIN
NC3827EOtherBCBSNC
NC2009351NMedicare PIN
SC194603Medicaid
NCNC38800386Medicare PIN
NCNC3880CMedicare PIN
NC2009351FMedicare PIN
NC2009351DMedicare PIN
NC2009351RMedicare PIN
NC893827EMedicaid
NC2009351JMedicare PIN
NC2009351MMedicare PIN
NC2009351SMedicare PIN
NC2009351GMedicare PIN
NC1174574149Medicaid
NCNC3880AMedicare PIN
NC2009351HMedicare PIN
NC2009351KMedicare PIN
NCNC3880FMedicare PIN
NC2009351PMedicare PIN
NCNC3880BMedicare PIN
NCNC3880DMedicare PIN
NCNC3880GMedicare PIN