Provider Demographics
NPI:1417118522
Name:BASU, NABANITA (MD)
Entity Type:Individual
Prefix:
First Name:NABANITA
Middle Name:
Last Name:BASU
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:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:BLDG. # B, SUITE # 220
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7763
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61125126207R00000X
TXBP10032352207R00000X
TXP0342208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287623704Medicaid
TX287623701Medicaid
TX287623703Medicaid
TX287623705Medicaid
TXP00997928Medicare PIN
TX287623705Medicaid
TX287623704Medicaid
TXTXB155594Medicare PIN
TXTXB139034Medicare PIN
TX287623703Medicaid