Provider Demographics
NPI:1326357666
Name:BASU, NILADRI (MD)
Entity Type:Individual
Prefix:DR
First Name:NILADRI
Middle Name:
Last Name:BASU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 W. COLORADO BLVD.
Mailing Address - Street 2:PAVILION II SUITE 431
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-947-3684
Mailing Address - Fax:214-947-3686
Practice Address - Street 1:221 W. COLORADO BLVD.
Practice Address - Street 2:PAVILION II SUITE 431
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-947-3684
Practice Address - Fax:214-947-3686
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3117207X00000X, 207XX0801X
NY285955207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery