Provider Demographics
NPI:1952389074
Name:BASU, SANGHAMITRA (MD)
Entity type:Individual
Prefix:DR
First Name:SANGHAMITRA
Middle Name:
Last Name:BASU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SANGHAMITRA
Other - Middle Name:
Other - Last Name:DAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11401207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506996Medicaid
NVV103915Medicare PIN
I29927Medicare UPIN