Provider Demographics
NPI:1841223310
Name:BASSILIOS, FOUAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:FOUAD
Middle Name:A
Last Name:BASSILIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 THORN RUN RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2861
Mailing Address - Country:US
Mailing Address - Phone:412-262-4130
Mailing Address - Fax:412-262-9109
Practice Address - Street 1:935 THORN RUN RD
Practice Address - Street 2:SUITE 214
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2861
Practice Address - Country:US
Practice Address - Phone:412-262-4130
Practice Address - Fax:412-262-9109
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032567L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007544200006Medicaid
PA0007544200006Medicaid
B36526Medicare UPIN