Provider Demographics
NPI:1033174123
Name:BASU, TAPENDU (MD)
Entity Type:Individual
Prefix:
First Name:TAPENDU
Middle Name:
Last Name:BASU
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 1:680 POOLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6003
Mailing Address - Country:US
Mailing Address - Phone:410-386-9099
Mailing Address - Fax:410-386-9098
Practice Address - Street 1:680 POOLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6003
Practice Address - Country:US
Practice Address - Phone:410-386-9099
Practice Address - Fax:410-386-9098
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058397207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10494Medicare UPIN
824RMedicare PIN