Provider Demographics
NPI:1255626610
Name:BASKIN, NATHAN ADAM (MD)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:ADAM
Last Name:BASKIN
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 1:2222 MARONEAL ST
Mailing Address - Street 2:APARTMENT 545
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3242
Mailing Address - Country:US
Mailing Address - Phone:312-218-1590
Mailing Address - Fax:713-592-9997
Practice Address - Street 1:1709 DRYDEN RD
Practice Address - Street 2:SUITE 5.70
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2400
Practice Address - Country:US
Practice Address - Phone:713-798-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10041491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine