Healthcare Provider Details

I. General information

NPI: 1588811095
Provider Name (Legal Business Name): MANPREET BASI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANPREET BHULLAR MD

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 PHILADELPHIA PIKE
CLAYMONT DE
19703-2424
US

IV. Provider business mailing address

2093 PHILADELPHIA PIKE
CLAYMONT DE
19703-2424
US

V. Phone/Fax

Practice location:
  • Phone: 888-933-3122
  • Fax: 888-958-7819
Mailing address:
  • Phone: 888-933-3122
  • Fax: 888-958-7819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0055078
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA104993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: