Provider Demographics
NPI:1588700470
Name:M. R. BAKER, PC
Entity type:Organization
Organization Name:M. R. BAKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINNA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-667-4896
Mailing Address - Street 1:431 PENN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1623
Mailing Address - Country:US
Mailing Address - Phone:610-667-4896
Mailing Address - Fax:610-771-0871
Practice Address - Street 1:431 PENN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1623
Practice Address - Country:US
Practice Address - Phone:610-667-4896
Practice Address - Fax:610-771-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14906U53Medicare PIN
PA099241Medicare PIN