MEDICARE: MS. SUSAN BASILE NP

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	163WN0002X	Neonatal Intensive Care Registered Nurse	R098027	MD
2	363LN0005X	Critical Care Neonatal Nurse Practitioner	R098027	MD

General Provider Information

NPI Number	:	1780655308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN BASILE NP

Provider Business Mailing Address
First Line	:	PO BOX 2130
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20875-2130
Country	:	US
Telephone Number	:	240-364-2510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 FOREST GLEN RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1483
Country	:	US
Telephone Number	:	240-364-2510
Fax Number	:

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	12/11/2019

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