Provider Demographics
NPI:1316986342
Name:BASILE, PHILIP (DPM)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:BASILE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 COMMON ST # 307
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2704
Mailing Address - Country:US
Mailing Address - Phone:888-352-0082
Mailing Address - Fax:617-321-4075
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:DIVISION OF PODIATRY
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-499-5065
Practice Address - Fax:617-321-4075
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD1920213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0358053Medicaid
MA0358053Medicaid