Basic Information
| Provider Information | |||||||||
| NPI: | 1568556058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 652 CAMERON ROAD | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246583326 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 DUTCH RIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247734621 | ||||||||
| FaxNumber: | 7247734696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN531808 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | RN531808 | 01 | PA | RN LICENSE | OTHER |