Provider Demographics
NPI:1821386228
Name:BASU, DEV ADITYA GAUTAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DEV
Middle Name:ADITYA GAUTAM
Last Name:BASU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:913 SOUTHERLY ROAD
Mailing Address - Street 2:#264
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2629
Mailing Address - Country:US
Mailing Address - Phone:410-275-9164
Mailing Address - Fax:410-275-9164
Practice Address - Street 1:913 SOUTHERLY ROAD
Practice Address - Street 2:#264
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2629
Practice Address - Country:US
Practice Address - Phone:410-275-9164
Practice Address - Fax:410-275-9164
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2023-02-21
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Provider Licenses
StateLicense IDTaxonomies
MDD0079832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine