Provider Demographics
NPI:1851383517
Name:CHRYSSOS, BASIL E (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIL
Middle Name:E
Last Name:CHRYSSOS
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:PO BOX 4390
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-4390
Mailing Address - Country:US
Mailing Address - Phone:775-882-0430
Mailing Address - Fax:775-688-8031
Practice Address - Street 1:1470 MEDICAL PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4648
Practice Address - Country:US
Practice Address - Phone:775-445-7650
Practice Address - Fax:775-687-8457
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6678207RC0000X
CAA52334207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEN467ZOtherMEDICARE PTAN FOR CTPC
NVWCGXP11Medicare PIN
NVEN467ZOtherMEDICARE PTAN FOR CTPC