Provider Demographics
NPI:1700296118
Name:SANGHAMITRA BASU, M.D., P.C.
Entity type:Organization
Organization Name:SANGHAMITRA BASU, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGHAMITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-362-7246
Mailing Address - Street 1:6955 N DURANGO DR
Mailing Address - Street 2:SUITE 1115-301
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4411
Mailing Address - Country:US
Mailing Address - Phone:702-362-7246
Mailing Address - Fax:702-362-7272
Practice Address - Street 1:2435 FIRE MESA ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9009
Practice Address - Country:US
Practice Address - Phone:702-362-7246
Practice Address - Fax:702-362-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6721620001Medicare NSC