Provider Demographics
NPI:1992970602
Name:BAKER, CLYDE GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:GREGORY
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W 20TH ST
Mailing Address - Street 2:15U
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3649
Mailing Address - Country:US
Mailing Address - Phone:773-750-3792
Mailing Address - Fax:
Practice Address - Street 1:180 W 20TH ST
Practice Address - Street 2:15U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3649
Practice Address - Country:US
Practice Address - Phone:773-750-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY260746207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program