Provider Demographics
NPI:1992952865
Name:BASTON, CATHERINE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:BASTON
Suffix:
Gender:F
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:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1290
Mailing Address - Country:US
Mailing Address - Phone:434-385-5600
Mailing Address - Fax:434-455-7172
Practice Address - Street 1:1825 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-3967
Practice Address - Country:US
Practice Address - Phone:434-385-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35272207W00000X
VA0101268706207W00000X
TXN4935207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01134421OtherRAILROAD MEDICARE
SC352727Medicaid
SCSC01537951Medicare PIN