Provider Demographics
NPI:1487831376
Name:AZKUL, BASSEM (MD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:AZKUL
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 1:841 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-2026
Mailing Address - Country:US
Mailing Address - Phone:603-934-0177
Mailing Address - Fax:603-934-2805
Practice Address - Street 1:22 STRAFFORD ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-4701
Practice Address - Country:US
Practice Address - Phone:603-366-1070
Practice Address - Fax:603-366-1071
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13613207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207456Medicaid
NH000466401Medicare Oscar/Certification