Provider Demographics
NPI:1831144039
Name:BISWAS, DEBASHIS (MD)
Entity type:Individual
Prefix:
First Name:DEBASHIS
Middle Name:
Last Name:BISWAS
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 1:6325 HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2300
Mailing Address - Country:US
Mailing Address - Phone:901-522-7700
Mailing Address - Fax:662-536-0566
Practice Address - Street 1:97 STATELINE RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1724
Practice Address - Country:US
Practice Address - Phone:662-536-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN377732084N0400X
MSM182152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
470882104OtherUNITED HEALTHCARE
470882104OtherTRICARE
H19481OtherHEALTHSPRINGS
0019896OtherCIGNA
TN4076438OtherBCBS OF TENNESSEE
TNQ015836Medicaid
7486187OtherAETNA
TN388061Medicaid
MS08601532Medicaid
29610OtherTLC
H19481OtherHEALTHSPRINGS
470882104OtherTRICARE
7486187OtherAETNA