Basic Information
| Provider Information | |||||||||
| NPI: | 1033192745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | GENE | ||||||||
| MiddleName: | BENJAMIN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2137 LAKESIDE DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245016806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343854184 | ||||||||
| FaxNumber: | 4343858616 | ||||||||
| Practice Location | |||||||||
| Address1: | 2137 LAKESIDE DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245016806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343854184 | ||||||||
| FaxNumber: | 4343858616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 08/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110002119 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 008344C68 | 01 | MEDICARE PROVIDER NUMBER PRIOR TO 09/01/07 | OTHER | 010179301 | 05 | VA | MEDICAID | 1528155892 | 01 | VA | CVFP CORPORATR NPI | OTHER | CA2436 | 01 | MEDICARE RAILROAD GROUP NUMBER | OTHER | P00370488 | 01 | MEDICARE RAILROAD PROVIDER NUMBER | OTHER | 1528155892 | 05 | VA | MEDICAID | 1972680049 | 01 | VA | CVFP SITE NPI | OTHER | CO3658 | 01 | VA | MEDICARE GROUP PTAN | OTHER | C08183 | 01 | MEDICARE GROUP NUMBER PRIOR TO 09/01/07 | OTHER |