Provider Demographics
NPI:1598728099
Name:DAS, DEBASISH (MD)
Entity Type:Individual
Prefix:
First Name:DEBASISH
Middle Name:
Last Name:DAS
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 1:501 KINGS HWY E
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4867
Mailing Address - Country:US
Mailing Address - Phone:203-335-4193
Mailing Address - Fax:203-331-9006
Practice Address - Street 1:501 KINGS HWY E
Practice Address - Street 2:SUITE 106
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4867
Practice Address - Country:US
Practice Address - Phone:203-335-4193
Practice Address - Fax:203-331-9006
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001358383Medicaid
CT001358383Medicaid
CT110006764Medicare ID - Type Unspecified