Provider Demographics
NPI:1144279654
Name:BAKER, ALLYSON (MD)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name: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 1:924 MONTCLAIR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1211
Mailing Address - Country:US
Mailing Address - Phone:205-591-7999
Mailing Address - Fax:205-591-5051
Practice Address - Street 1:924 MONTCLAIR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1211
Practice Address - Country:US
Practice Address - Phone:205-591-7999
Practice Address - Fax:205-591-5051
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24402207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009912323Medicaid
AL510I220006Medicare PIN
ALI54071Medicare UPIN