Provider Demographics
NPI:1013266063
Name:BASKIN, KEVIN D
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:BASKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TREVOR CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28457-9562
Mailing Address - Country:US
Mailing Address - Phone:224-234-7977
Mailing Address - Fax:
Practice Address - Street 1:14 TREVOR CT
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NC
Practice Address - Zip Code:28457-9562
Practice Address - Country:US
Practice Address - Phone:224-234-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman