MEDICARE: ANA CRISTINA BASSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	0101252920	VA

General Provider Information

NPI Number	:	1023096377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA CRISTINA BASSO MD

Provider Business Mailing Address
First Line	:	100 KINGSLEY LN STE 200
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23505-4604
Country	:	US
Telephone Number	:	757-451-0929
Fax Number	:	757-423-4901

Provider Business Practice Location Address
First Line	:	301-6 GREAT TEAYS BLVD
Second Line	:
City	:	SCOTT DEPOT
State	:	WV
Zip	:	25560
Country	:	US
Telephone Number	:	304-757-6999
Fax Number	:	304-757-3252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	03/16/2020

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