Provider Demographics
NPI:1538130257
Name:BASTA, BAHER A (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHER
Middle Name:A
Last Name:BASTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5234 DEFORD RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-7208
Mailing Address - Country:US
Mailing Address - Phone:757-499-6978
Mailing Address - Fax:858-925-1353
Practice Address - Street 1:3800 POPLAR HILL RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5522
Practice Address - Country:US
Practice Address - Phone:757-499-6978
Practice Address - Fax:858-925-1353
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237664207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010296463Medicaid
VA010296463Medicaid
VAP00373880Medicare PIN
VA010699M55Medicare PIN