Healthcare Provider Details

I. General information

NPI: 1710944707
Provider Name (Legal Business Name): HABIB FOUAD BASSIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 WILBORN AVE SUITE A
SOUTH BOSTON VA
24592-1662
US

IV. Provider business mailing address

4402 BRENTWOOD DR
SOUTH BOSTON VA
24592-2955
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-8977
  • Fax: 434-572-2510
Mailing address:
  • Phone: 434-572-1381
  • Fax: 434-572-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101044555
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: