Provider Demographics
NPI:1386778264
Name:BAKER, PENNY JOANN SMITH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:JOANN SMITH
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1835 GLEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5213
Mailing Address - Country:US
Mailing Address - Phone:410-665-7707
Mailing Address - Fax:410-261-8097
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-932-5100
Practice Address - Fax:410-261-8097
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0001016363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical