Provider Demographics
NPI:1003814351
Name:BASRA, RAJINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJINDER
Middle Name:
Last Name:BASRA
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 1:5685 SHIMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9722
Mailing Address - Country:US
Mailing Address - Phone:716-741-6119
Mailing Address - Fax:
Practice Address - Street 1:194 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2113
Practice Address - Country:US
Practice Address - Phone:585-345-1779
Practice Address - Fax:585-345-1862
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF92553Medicare UPIN
NY130910BMedicare PIN