Healthcare Provider Details

I. General information

NPI: 1174781611
Provider Name (Legal Business Name): GREGORY ASHTON BASSMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST SUITE 201
BALTIMORE MD
21204-6800
US

IV. Provider business mailing address

PO BOX 418953
BOSTON MA
02241-8953
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-3901
  • Fax: 443-849-3902
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD77581
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: