Provider Demographics
NPI:1790793586
Name:BASU, SABREENA M (MD)
Entity Type:Individual
Prefix:
First Name:SABREENA
Middle Name:M
Last Name:BASU
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1365 CLIFTON RD NE BLDG A
Mailing Address - Street 2:INTERNAL MEDICINE/ENDOCRINOLOGY SUITE 4400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-3280
Mailing Address - Fax:404-778-5730
Practice Address - Street 1:1365 CLIFTON RD NE BLDG A
Practice Address - Street 2:INTERNAL MEDICINE/ENDOCRINOLOGY SUITE 4400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-3280
Practice Address - Fax:404-778-5730
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-08-26
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Provider Licenses
StateLicense IDTaxonomies
GA055725207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG84545Medicare UPIN