Provider Demographics
NPI:1285607846
Name:BAKER, ALAN R (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:619 ASTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2035
Mailing Address - Country:US
Mailing Address - Phone:301-340-3025
Mailing Address - Fax:703-560-3008
Practice Address - Street 1:3301 WOODBURN RD
Practice Address - Street 2:209
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-560-3007
Practice Address - Fax:703-560-3008
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-051805208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA73-0893-1Medicaid
VAF98656Medicare UPIN
VA616164Medicare ID - Type Unspecified