Provider Demographics
NPI:1639134380
Name:BASILIADIS, MARGARET (DO)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:BASILIADIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:CATHERINE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:2700 PROSPERITY AVE STE 270
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4321
Practice Address - Country:US
Practice Address - Phone:703-698-2431
Practice Address - Fax:571-665-6878
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1776207QG0300X
VA0102206268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8510K0Medicare PIN