Provider Demographics
NPI:1043278872
Name:BASSETT, CARRIE A (DO)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:A
Last Name:BASSETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932127
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0001
Mailing Address - Country:US
Mailing Address - Phone:216-472-2730
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:11201 SHAKER BLVD
Practice Address - Street 2:SUITE 102A
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3869
Practice Address - Country:US
Practice Address - Phone:216-721-6900
Practice Address - Fax:216-268-7905
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2579713Medicaid
OH4163513Medicare PIN
OH4163512Medicare PIN
I34305Medicare UPIN