Provider Demographics
NPI:1962469148
Name:BASSANELLI, ANTHONY GERARD (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GERARD
Last Name:BASSANELLI
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 1:44530 SAN PABLO AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3598
Mailing Address - Country:US
Mailing Address - Phone:760-341-6026
Mailing Address - Fax:760-341-6027
Practice Address - Street 1:44530 SAN PABLO AVE STE 202
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3598
Practice Address - Country:US
Practice Address - Phone:760-341-6026
Practice Address - Fax:760-341-6027
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG558202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY179072OtherMEDICAL LICENSE
CAG-55820OtherMEDICAL LICENSE
A93397Medicare UPIN