Provider Demographics
NPI:1053370098
Name:BAKER, CLIFTON A (MD)
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:A
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 1:18539 S. N.C. HWY 109
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239-6807
Mailing Address - Country:US
Mailing Address - Phone:336-859-5001
Mailing Address - Fax:336-859-1952
Practice Address - Street 1:18539 S NC HIGHWAY 109
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239-7713
Practice Address - Country:US
Practice Address - Phone:336-859-5001
Practice Address - Fax:336-859-1952
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28122208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC930123535OtherRAILROAD MEDICARE
NC12739OtherBLUE CROSS
NC8913112Medicaid
NCC81805Medicare UPIN
NC8913112Medicaid