Provider Demographics
NPI:1194950717
Name:BAKER, THOMAS R (HIS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:BAKER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 SAM RITTENBERG BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4138
Mailing Address - Country:US
Mailing Address - Phone:843-571-0744
Mailing Address - Fax:843-571-0743
Practice Address - Street 1:1565 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4138
Practice Address - Country:US
Practice Address - Phone:843-571-0744
Practice Address - Fax:843-571-0743
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC438237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist