Provider Demographics
NPI:1932102399
Name:BASARAB, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BASARAB
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4083
Mailing Address - Fax:717-812-2244
Practice Address - Street 1:35 MONUMENT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5074
Practice Address - Country:US
Practice Address - Phone:717-812-4083
Practice Address - Fax:717-812-2244
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028803E2085R0202X, 207U00000X, 2085N0904X, 207UN0902X, 207UN0901X, 207UN0903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD056566100Medicaid
PA300047027OtherRAILROAD MEDICARE
PA129377OtherHIGHMARK BLUE SHIELD
PA129377YYYOtherMEDICARE PTAN
PA1521152OtherGATEWAY
PA0914589Medicaid
PA30123079OtherAMERIHEALTH MERCY
PA129377OtherHIGHMARK BLUE SHIELD
PA30123079OtherAMERIHEALTH MERCY
PA129377YYYOtherMEDICARE PTAN