Provider Demographics
NPI:1285620039
Name:BAKER, MATT DANE (PA-C)
Entity type:Individual
Prefix:MR
First Name:MATT
Middle Name:DANE
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 BRIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-1930
Mailing Address - Country:US
Mailing Address - Phone:215-630-9647
Mailing Address - Fax:
Practice Address - Street 1:108 MDG. NJ AIR NATIONAL GUARD.
Practice Address - Street 2:3466 NEELY ROAD. MCGUIRE AFB
Practice Address - City:WRIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08641-5406
Practice Address - Country:US
Practice Address - Phone:609-754-2635
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000629L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical