Provider Demographics
NPI:1548235732
Name:BASILE, JOHN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:BASILE
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 1:3020 HAMAKER COURT
Mailing Address - Street 2:SUITE B-111
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2220
Mailing Address - Country:US
Mailing Address - Phone:703-876-0288
Mailing Address - Fax:703-876-0290
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE B-111
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2220
Practice Address - Country:US
Practice Address - Phone:703-876-0288
Practice Address - Fax:703-876-0290
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043115208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE22120Medicare UPIN
DCBA437447Medicare PIN