Organization
CONCUSSION MANAGEMENT CENTER OF CENTRAL PA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A BAKER DO (PHYSICIAN)
(814) 224-6096
Entity
Organization
Contact information
Practice address
111 NASON DR, SUITE 104, ROARING SPRING, PA 16673-1212
(814) 224-6096
(814) 224-6095
Mailing address
111 NASON DR, SUITE 104, ROARING SPRING, PA 16673-1212
(814) 224-6096
(814) 224-6095
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
PA
Enumeration date
02/27/2013
Last updated
02/27/2013
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