Provider Demographics
NPI:1154398253
Name:BAKER, CARL W (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:W
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 1:15 LAFAYETTE PL STE C
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2277
Mailing Address - Country:US
Mailing Address - Phone:843-715-2424
Mailing Address - Fax:843-715-2945
Practice Address - Street 1:15 LAFAYETTE PL STE C
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2277
Practice Address - Country:US
Practice Address - Phone:843-715-2424
Practice Address - Fax:843-715-2945
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17421207W00000X, 207WX0107X
KY32965207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000044963OtherANTHEM BCBS
KY7100053130Medicaid
KY64329659Medicaid
180029586OtherRAILROAD MEDICARE
610706763OtherTRICARE
0584204Medicare PIN