Provider Demographics
NPI:1407424880
Name:BASKIN, BRENT MAXWELL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:MAXWELL
Last Name:BASKIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1272
Mailing Address - Country:US
Mailing Address - Phone:413-205-1200
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1272
Practice Address - Country:US
Practice Address - Phone:413-205-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant