Provider Demographics
NPI:1336123272
Name:BASCH, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:BASCH
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 1:660 PENNSYLVANIA AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4346
Mailing Address - Country:US
Mailing Address - Phone:202-546-4504
Mailing Address - Fax:202-544-6136
Practice Address - Street 1:660 PENNSYLVANIA AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4346
Practice Address - Country:US
Practice Address - Phone:202-546-4504
Practice Address - Fax:202-544-6136
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD11863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC003962M07Medicare ID - Type Unspecified
DCD05854Medicare UPIN