Healthcare Provider Details

I. General information

NPI: 1982028379
Provider Name (Legal Business Name): SANKHA SUBHRA BASU M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL, DEPARTMENT OF PATHOLOGY
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL, DEPARTMENT OF PATHOLOGY
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-8019
  • Fax:
Mailing address:
  • Phone: 617-525-8019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number255867
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number277235
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: