1699918318 NPI number — TAPENDU K BASU MD

Table of content: (NPI 1699918318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699918318 NPI number — TAPENDU K BASU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAPENDU K BASU MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699918318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 POOLE RD
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-6003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-386-9099
Provider Business Mailing Address Fax Number:
410-386-9098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 POOLE RD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-386-9099
Provider Business Practice Location Address Fax Number:
410-386-9098
Provider Enumeration Date:
04/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BASU
Authorized Official First Name:
TAPENDU
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEDICAL DIRCECTOR
Authorized Official Telephone Number:
410-386-9099

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  D0058397 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6687034 . This is a "UHC HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F7800001 . This is a "BC - DC METRO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1B16TK61494803 . This is a "BC - MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4002258 . This is a "UHC - PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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