Healthcare Provider Details

I. General information

NPI: 1285633164
Provider Name (Legal Business Name): MAXIM BASHKIROV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH SERVICE AVE
NORTH PROVIDENCE RI
02904-5113
US

IV. Provider business mailing address

PO BOX 844058
DALLAS TX
75284-4058
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-3000
  • Fax:
Mailing address:
  • Phone: 833-479-0697
  • Fax: 407-386-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number227241
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD11381
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: