Provider Demographics
NPI:1639525363
Name:BASSI, SHIVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:
Last Name:BASSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HOSPITAL DR STE 108
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5806
Mailing Address - Country:US
Mailing Address - Phone:410-863-8860
Mailing Address - Fax:410-766-7305
Practice Address - Street 1:325 HOSPITAL DR STE 108
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5806
Practice Address - Country:US
Practice Address - Phone:410-863-8860
Practice Address - Fax:410-766-7305
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2024-01-22
Deactivation Date:2019-07-17
Deactivation Code:
Reactivation Date:2019-08-09
Provider Licenses
StateLicense IDTaxonomies
MDD86894207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist