Individual
JAMES J BAEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 766-3600
(304) 343-4626
Mailing address
PO BOX 840, LIMA, OH 45802-0840
(877) 574-7116
(419) 223-2726
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
18837
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000023074
BLUE CROSS
WV
05
—
0121594000
—
WV
Enumeration date
06/01/2005
Last updated
03/17/2018
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