Provider Demographics
NPI:1588468110
Name:BAXTER, MARK ANTHONY SR
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:BAXTER
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-5320
Mailing Address - Country:US
Mailing Address - Phone:937-313-5782
Mailing Address - Fax:
Practice Address - Street 1:3214 HOOVER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-5320
Practice Address - Country:US
Practice Address - Phone:937-313-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty