MEDICARE: DR. GARY ALAN BASS 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	2086S0102X	Surgical Critical Care Physician	MD472249	PA
2	208600000X	Surgery Physician	MD472249	PA
3	2086S0127X	Trauma Surgery Physician	MD472249	PA

General Provider Information

NPI Number	:	1881924801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY ALAN BASS MD

Provider Business Mailing Address
First Line	:	3910 N POWELTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2640
Country	:	US
Telephone Number	:	215-349-8310
Fax Number	:	215-893-7270

Provider Business Practice Location Address
First Line	:	3400 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4238
Country	:	US
Telephone Number	:	215-349-8310
Fax Number	:	215-893-7270

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	12/17/2025

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