Healthcare Provider Details

I. General information

NPI: 1780768085
Provider Name (Legal Business Name): BASSEL F SHNEKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6356 SKIPPING STONE DR
NEW ALBANY OH
43054-5024
US

IV. Provider business mailing address

10275 LITTLE PATUXENT PKWY STE 300
COLUMBIA MD
21044-3445
US

V. Phone/Fax

Practice location:
  • Phone: 734-773-4314
  • Fax:
Mailing address:
  • Phone: 410-740-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTM2018-0208
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35081530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: