Provider Demographics
NPI:1962882381
Name:BASILE, FRITZ ALBERT (DO)
Entity type:Individual
Prefix:
First Name:FRITZ
Middle Name:ALBERT
Last Name:BASILE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14 MEDICAL PARK, STE 350
Mailing Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-3790
Mailing Address - Fax:803-434-3946
Practice Address - Street 1:14 MEDICAL PARK, STE 350
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-3790
Practice Address - Fax:803-434-3946
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37673208D00000X
SCLL37673207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice