Provider Demographics
NPI:1790737500
Name:BASKHAROUN, RAWYA S (MD)
Entity Type:Individual
Prefix:
First Name:RAWYA
Middle Name:S
Last Name:BASKHAROUN
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 130
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-0130
Mailing Address - Country:US
Mailing Address - Phone:718-833-7063
Mailing Address - Fax:718-833-2158
Practice Address - Street 1:7510 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3244
Practice Address - Country:US
Practice Address - Phone:718-833-7063
Practice Address - Fax:718-833-2158
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184170207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01558007Medicaid
F86604Medicare UPIN
NY24J343Medicare PIN