Provider Demographics
NPI:1699725242
Name:BAKER, KAREN TAPP (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:TAPP
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6268
Mailing Address - Country:US
Mailing Address - Phone:912-350-5937
Mailing Address - Fax:912-350-3483
Practice Address - Street 1:4750 WATERS AVE STE 311
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-5937
Practice Address - Fax:912-350-3483
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201550207V00000X
GA66251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003113902BMedicaid
GA003113902CMedicaid
SCGA1250Medicaid
GAP00999565OtherRAILROAD MEDICARE
GA003113902DMedicaid
GA003113902EMedicaid
GA003113902AMedicaid
GA202I169308Medicare PIN
SCGA1250Medicaid