Provider Demographics
NPI:1104884279
Name:BAKER, SCOTT WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 HEALY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1404
Mailing Address - Country:US
Mailing Address - Phone:336-768-3530
Mailing Address - Fax:336-768-1329
Practice Address - Street 1:3318 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1404
Practice Address - Country:US
Practice Address - Phone:336-768-3530
Practice Address - Fax:336-768-1329
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-34813207L00000X
NC34813208VP0014X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I 0004366748OtherAETNA
NCP00185717OtherRR MEDICARE
NC8912745Medicaid
NCP00185717OtherRR MEDICARE
NC8912745Medicaid