Healthcare Provider Details

I. General information

NPI: 1467795724
Provider Name (Legal Business Name): YAROSLAV BASYUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 PLEASANT ST
CONCORD NH
03301-2551
US

IV. Provider business mailing address

264 PLEASANT ST
CONCORD NH
03301-2551
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3368
  • Fax: 603-228-7268
Mailing address:
  • Phone: 603-224-3368
  • Fax: 603-228-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD471969
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19873
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD471969
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number19873
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: