Healthcare Provider Details

I. General information

NPI: 1932043601
Provider Name (Legal Business Name): ENDEAVOUR HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MARKET ST # A
HAVRE DE GRACE MD
21078-3301
US

IV. Provider business mailing address

913 SOUTHERLY RD APT 264
TOWSON MD
21204-2629
US

V. Phone/Fax

Practice location:
  • Phone: 443-275-9164
  • Fax:
Mailing address:
  • Phone: 443-275-9164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEV ADITYA GAUTAM BASU
Title or Position: OWNER
Credential:
Phone: 413-794-8490