Provider Demographics
NPI:1952480162
Name:BASH, DENNIS P (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:P
Last Name:BASH
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 63213
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3213
Mailing Address - Country:US
Mailing Address - Phone:800-279-1395
Mailing Address - Fax:517-694-6441
Practice Address - Street 1:1638 OWEN DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3234
Practice Address - Country:US
Practice Address - Phone:910-609-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34818208000000X, 2080P0204X
LA097252080P0204X
GA0451662080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905517Medicaid
NC5905517Medicaid