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NPI Code Detail

MEDICARE: SUSANNA NILA BASAPPA MD, PHD

MEDICARE: SUSANNA NILA BASAPPA MD, PHD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramRS2023-1193NM
2390200000XStudent in an Organized Health Care Education/Training ProgramNM
3207QA0401XAddiction Medicine (Family Medicine) PhysicianMD.MD.70104522WA

General Provider Information

NPI Number : 1487358123
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANNA NILA BASAPPA MD, PHD
Provider Business Mailing Address
First Line : 325 9TH AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98104-2420
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 325 9TH AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98104-2420
Country : US
Telephone Number : 206-744-1832
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2023
Last Update Date : 05/29/2026

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