Provider Demographics
NPI:1871708446
Name:BAKER, PENNY DAWNIEL (MD)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:DAWNIEL
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 CLARK RD S
Mailing Address - Street 2:
Mailing Address - City:LA RUE
Mailing Address - State:OH
Mailing Address - Zip Code:43332-9231
Mailing Address - Country:US
Mailing Address - Phone:740-360-9966
Mailing Address - Fax:
Practice Address - Street 1:4879 U.S. 68 SOUTH
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357
Practice Address - Country:US
Practice Address - Phone:937-599-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092237207P00000X, 207Q00000X
OH57-010113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine