Provider Demographics
NPI:1689929820
Name:BASANI, SAMATA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMATA
Middle Name:
Last Name:BASANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMATA
Other - Middle Name:
Other - Last Name:ATLURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1153 W JOHN CARPENTER FWY STE 102
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2524
Mailing Address - Country:US
Mailing Address - Phone:469-291-0770
Mailing Address - Fax:888-443-9001
Practice Address - Street 1:1153 W JOHN CARPENTER FWY STE 102
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2524
Practice Address - Country:US
Practice Address - Phone:469-291-0770
Practice Address - Fax:888-443-9001
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5776207R00000X, 207RE0101X
GA068176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX414064YSFZOtherMEDICARE PTAN
TX3461097 01Medicaid