Provider Demographics
NPI:1104991645
Name:DOLPHIN, BASIL (MD)
Entity type:Individual
Prefix:DR
First Name:BASIL
Middle Name:
Last Name:DOLPHIN
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 1:2525 BLACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-5211
Mailing Address - Country:US
Mailing Address - Phone:484-884-2249
Mailing Address - Fax:484-884-8034
Practice Address - Street 1:2649 SCHOENERSVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7326
Practice Address - Country:US
Practice Address - Phone:484-884-2249
Practice Address - Fax:484-884-8034
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062171-L2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102641760-0001Medicaid
PA100730341-0008Medicaid
PAA61758Medicare UPIN