Provider Demographics
NPI:1679683486
Name:BAXTER, RIC ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:RIC
Middle Name:ALAN
Last Name:BAXTER
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 1:2455 BLACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-5207
Mailing Address - Country:US
Mailing Address - Phone:610-997-7120
Mailing Address - Fax:610-997-7107
Practice Address - Street 1:2455 BLACK RIVER RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-5207
Practice Address - Country:US
Practice Address - Phone:610-997-7120
Practice Address - Fax:610-997-7107
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026616E207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC34421Medicare UPIN