Provider Demographics
NPI:1861472102
Name:BASKAR, GOVIN (MD)
Entity Type:Individual
Prefix:
First Name:GOVIN
Middle Name:
Last Name:BASKAR
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 1:14601 DETROIT AVE
Mailing Address - Street 2:395
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4214
Mailing Address - Country:US
Mailing Address - Phone:216-529-7780
Mailing Address - Fax:216-529-0345
Practice Address - Street 1:14601 DETROIT AVE
Practice Address - Street 2:395
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4214
Practice Address - Country:US
Practice Address - Phone:216-529-7780
Practice Address - Fax:216-529-0345
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-072315208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000133634OtherANTHEM
OH2008973Medicaid
OH2008973Medicaid
OHG82711Medicare UPIN