Provider Demographics
NPI:1558376137
Name:BASALA, PHILIP ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:BASALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 SUNNY MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:MD
Mailing Address - Zip Code:21561-2677
Mailing Address - Country:US
Mailing Address - Phone:412-848-2631
Mailing Address - Fax:
Practice Address - Street 1:POTOMAC VALLEY HOSPITAL
Practice Address - Street 2:100 PIN OAK LANE
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726
Practice Address - Country:US
Practice Address - Phone:304-597-3510
Practice Address - Fax:304-597-3513
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0099654207VF0040X
WV1245207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012925630006Medicaid
PA0012925630006Medicaid
PA0012925630006Medicaid