Provider Demographics
NPI:1326149238
Name:BASON, MARGARET M (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:BASON
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 1:225 HOPMEADOW STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06089
Mailing Address - Country:US
Mailing Address - Phone:860-651-1766
Mailing Address - Fax:
Practice Address - Street 1:225 HOPMEADOW STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06089
Practice Address - Country:US
Practice Address - Phone:860-651-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033798207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070000317Medicare PIN
CT070000317Medicare ID - Type Unspecified
B87025Medicare UPIN