Healthcare Provider Details

I. General information

NPI: 1265659148
Provider Name (Legal Business Name): SONALI BASU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW WW3-100
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

2527 S KENMORE CT
ARLINGTON VA
22206-2372
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5923
  • Fax:
Mailing address:
  • Phone: 703-517-7463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberMD036550
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: