Healthcare Provider Details

I. General information

NPI: 1699354100
Provider Name (Legal Business Name): ARJUN BASHYAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PARK AVE STE 509
WORCESTER MA
01609-1989
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

V. Phone/Fax

Practice location:
  • Phone: 508-890-5500
  • Fax:
Mailing address:
  • Phone: 214-648-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1028279
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number1028279
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: