Healthcare Provider Details

I. General information

NPI: 1285830570
Provider Name (Legal Business Name): STEPHEN A. BASKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST SUITE 422
BERKELEY CA
94705-2146
US

IV. Provider business mailing address

2999 REGENT ST SUITE 422
BERKELEY CA
94705-2146
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-0748
  • Fax:
Mailing address:
  • Phone: 510-845-0784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA35451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: