Provider Demographics
NPI:1356371785
Name:MAGHAK, BASIL (MD)
Entity type:Individual
Prefix:DR
First Name:BASIL
Middle Name:
Last Name:MAGHAK
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 1:1850 TOWN CENTER PKWY
Mailing Address - Street 2:SUITE 258
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3219
Mailing Address - Country:US
Mailing Address - Phone:703-435-1454
Mailing Address - Fax:703-435-8630
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:SUITE 258
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-435-1454
Practice Address - Fax:703-435-8630
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD004408207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD234401700Medicaid
MDF86298Medicare UPIN
MD885130Medicare ID - Type Unspecified