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NPI Code Detail

MEDICARE: MR. THANESSERI BASKARAN MD

MEDICARE: MR. THANESSERI BASKARAN 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
12084P0800XPsychiatry PhysicianME0077201FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598702938
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THANESSERI BASKARAN MD
Provider Business Mailing Address
First Line : 400 E SHERIDAN RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3122
Country : US
Telephone Number : 321-639-5709
Fax Number :
Provider Business Practice Location Address
First Line : 400 E SHERIDAN RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3122
Country : US
Telephone Number : 321-639-5709
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 09/10/2010

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