Provider Demographics
NPI:1548020654
Name:BAKER, JOHN ALBERT JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2338
Mailing Address - Country:US
Mailing Address - Phone:732-890-1899
Mailing Address - Fax:
Practice Address - Street 1:1519 7TH AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2338
Practice Address - Country:US
Practice Address - Phone:732-890-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant