Provider Demographics
NPI:1942287412
Name:BASHKOFF, ERIC M (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:BASHKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:109 PHILIP ROTH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1393
Practice Address - Country:US
Practice Address - Phone:757-873-6434
Practice Address - Fax:757-873-1882
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101049114208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010181933Medicaid
VA010181933Medicaid
VA015198R53Medicare PIN
VAP00308925Medicare PIN