Healthcare Provider Details

I. General information

NPI: 1861015935
Provider Name (Legal Business Name): BASU RAY CARDIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 05/25/2020
Certification Date: 05/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 GROVEWAY DR
GERMANTOWN TN
38139-5554
US

IV. Provider business mailing address

1755 GROVEWAY DR
GERMANTOWN TN
38139-5554
US

V. Phone/Fax

Practice location:
  • Phone: 617-433-7775
  • Fax:
Mailing address:
  • Phone: 617-433-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: INDRANILL BASU RAY
Title or Position: PRESIDENT
Credential: MD
Phone: 617-308-0580