Healthcare Provider Details

I. General information

NPI: 1215977756
Provider Name (Legal Business Name): ROBERT D BASOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W. MAIN ST.
HOPKINTON MA
01748
US

IV. Provider business mailing address

77 W. MAIN ST.
HOPKINTON MA
01748
US

V. Phone/Fax

Practice location:
  • Phone: 508-435-5506
  • Fax: 508-497-5079
Mailing address:
  • Phone: 508-435-5506
  • Fax: 508-497-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: