Provider Demographics
NPI:1588732804
Name:GEORGI, BASIL A (MD)
Entity type:Individual
Prefix:
First Name:BASIL
Middle Name:A
Last Name:GEORGI
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 1:1711 27TH STREET, BRAUNLIN BUILDING
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-353-8661
Mailing Address - Fax:740-354-3254
Practice Address - Street 1:1711 27TH STREET, BRAUNLIN BLDG
Practice Address - Street 2:SUITE 306
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-353-8661
Practice Address - Fax:740-354-3254
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35070727208600000X
OH35-070727208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000332646OtherANTHEM
OH0317606Medicaid
OHGE0816073Medicare ID - Type Unspecified
OHA12996Medicare UPIN
OH0816073Medicare PIN
OH000000332646OtherANTHEM