Healthcare Provider Details

I. General information

NPI: 1366978108
Provider Name (Legal Business Name): GEORGES BASILE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL, YAWKEY 3550
BOSTON MA
02114-2621
US

IV. Provider business mailing address

221 MASSACHUSSETS AVENUE SUITE 310
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-2823
  • Fax: 617-726-2085
Mailing address:
  • Phone: 857-540-8891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number269908
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number269908
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: