Provider Demographics
NPI:1407178858
Name:BASKIN, SUSAN RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RAE
Last Name:BASKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2780
Mailing Address - Country:US
Mailing Address - Phone:207-780-0045
Mailing Address - Fax:207-221-5556
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-780-0045
Practice Address - Fax:207-221-5556
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME014850208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics