Provider Demographics
NPI:1932360450
Name:BAKER, MARY S (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1419 N VEAUX LOOP
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1259
Mailing Address - Country:US
Mailing Address - Phone:757-353-8122
Mailing Address - Fax:757-261-0173
Practice Address - Street 1:5801 BREMO RD # 209
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-281-8210
Practice Address - Fax:804-410-4616
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257165207RP1001X, 207RC0200X
IN01067684207R00000X
NMMD2023-1245207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932360450Medicaid
IN201020340Medicaid
IN000000710972OtherANTHEM PIN