Provider Demographics
NPI:1427318393
Name:BAKER, ANDREW R (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
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 1:6365 WINCHESTER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-2069
Mailing Address - Country:US
Mailing Address - Phone:614-524-4146
Mailing Address - Fax:614-502-5613
Practice Address - Street 1:915 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3153
Practice Address - Country:US
Practice Address - Phone:614-293-8566
Practice Address - Fax:614-293-9024
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003568363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01161472OtherRAILROAD MEDICARE
OH0073038Medicaid
OHP01161472OtherRAILROAD MEDICARE