Provider Demographics
NPI:1487956538
Name:BAKER SURAJ, INC
Entity type:Organization
Organization Name:BAKER SURAJ, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-364-2822
Mailing Address - Street 1:602 N. LEWIS AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563
Mailing Address - Country:US
Mailing Address - Phone:337-364-2822
Mailing Address - Fax:337-364-1978
Practice Address - Street 1:602 N. LEWIS AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563
Practice Address - Country:US
Practice Address - Phone:337-364-2822
Practice Address - Fax:337-364-1978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAKER SURAJ, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1482030Medicaid
5E333Medicare PIN
G88059Medicare UPIN