Healthcare Provider Details

I. General information

NPI: 1285772244
Provider Name (Legal Business Name): VISVESHWAR BASKARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

2808 MARNAT RD
BALTIMORE MD
21209-2402
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6500
  • Fax:
Mailing address:
  • Phone: 410-955-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number01081105A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01081105A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberT4102
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: