Provider Demographics
NPI:1134166705
Name:BASILE, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BASILE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4461 STARKEY ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-345-4946
Mailing Address - Fax:540-982-7164
Practice Address - Street 1:4461 STARKEY ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-345-4946
Practice Address - Fax:540-343-7693
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110127672OtherRAILROAD MEDICARE
VA1134166705Medicaid
VA110006376OtherMEDICARE