Provider Demographics
NPI:1215997226
Name:BAKER, SANDRA K (MD)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:K
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:K
Other - Last Name:PARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-651-2980
Mailing Address - Fax:336-667-2047
Practice Address - Street 1:1919 W PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3564
Practice Address - Country:US
Practice Address - Phone:336-651-2980
Practice Address - Fax:336-667-2047
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913573Medicaid
NC8913573Medicaid
NC2022891AMedicare PIN