Provider Demographics
NPI:1699918318
Name:TAPENDU K BASU MD
Entity type:Organization
Organization Name:TAPENDU K BASU MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRCECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAPENDU
Authorized Official - Middle Name:K
Authorized Official - Last Name:BASU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-386-9099
Mailing Address - Street 1:680 POOLE RD
Mailing Address - Street 2:STE B
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6003
Mailing Address - Country:US
Mailing Address - Phone:410-386-9099
Mailing Address - Fax:410-386-9098
Practice Address - Street 1:680 POOLE RD
Practice Address - Street 2:STE B
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6003
Practice Address - Country:US
Practice Address - Phone:410-386-9099
Practice Address - Fax:410-386-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058397207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6687034OtherUHC HMO
MDF7800001OtherBC - DC METRO
MD1B16TK61494803OtherBC - MD
MD4002258OtherUHC - PPO