Provider Demographics
NPI:1750368908
Name:BATESON, BRIAN P (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:BATESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 WOODHULL COVE LN
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1642
Mailing Address - Country:US
Mailing Address - Phone:631-751-3040
Mailing Address - Fax:631-744-6205
Practice Address - Street 1:12 WOODHULL COVE LN
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1642
Practice Address - Country:US
Practice Address - Phone:631-751-3040
Practice Address - Fax:631-689-3416
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1867561207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01514272Medicaid
NY01514272Medicaid
NY25J891Medicare ID - Type Unspecified