Provider Demographics
NPI:1740238203
Name:BASSO, DEBORAH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANNE
Last Name:BASSO
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:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12181-0689
Mailing Address - Country:US
Mailing Address - Phone:518-268-5000
Mailing Address - Fax:
Practice Address - Street 1:1300 MASSACHUSETTS AVE
Practice Address - Street 2:DEPAUL WING
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1628
Practice Address - Country:US
Practice Address - Phone:518-268-5890
Practice Address - Fax:518-268-5596
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168265207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6999952OtherGHI
NY000406556008OtherBLUE SHIELD
NY743C71OtherBLUE CROSS
NY141655014OtherEMPIRE PLAN
NY01213390Medicaid
NY10000117OtherCDPHP
NY311991OtherWELLCARE
NY0005402789OtherAETNA
NY050202000029OtherFIDELIS
NY141655014OtherUNITED HEALTHCARE
NY86303OtherGHIHMO
NY15289OtherMVP
NY15289OtherMVP
NY01213390Medicaid
NYCC0799Medicare PIN