Provider Demographics
NPI:1144336157
Name:KENNETH W R BAKER, M.D.
Entity type:Organization
Organization Name:KENNETH W R BAKER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CARDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-286-4151
Mailing Address - Street 1:4018 FARBER CT
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9350
Mailing Address - Country:US
Mailing Address - Phone:614-286-4151
Mailing Address - Fax:
Practice Address - Street 1:793 W STATE ST
Practice Address - Street 2:MT CARMEL MEDICAL CENTER, MEDICAL EDUCATION
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1551
Practice Address - Country:US
Practice Address - Phone:614-234-5279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067314207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG75621Medicare UPIN