Individual
MR. MATTHEW G BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 E WT HARRIS BLVD, SUITE 5202, CHARLOTTE, NC 28262-3485
(704) 547-1495
(704) 547-1861
Mailing address
101 E WT HARRIS BLVD, SUITE 5202, CHARLOTTE, NC 28262-3485
(704) 547-1495
(704) 547-1861
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-03915
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
092552
HEALTH ALLIANCE PROV #
IL
05
—
1356349914
—
NC
01
—
713460
HEALTHLINK PROV #
IL
01
—
IL0111
JOHN DEERE PROV #
IL
01
—
P00108973
RR MEDICARE PROV #
IL
Enumeration date
07/08/2005
Last updated
06/17/2016
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