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General NPI Number Information
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NPI Number | 1053396572
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Entity Type | Individual
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Provider Name | PATRICK BASU M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 6735 CONROY RD STE 223
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City | ORLANDO
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State | FL
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Zip | 32835-3570
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Country | US
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Telephone | 407-203-2377
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Fax | 407-203-8811
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Provider Business Mailing Address
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Address Line | 9534 WICKHAM WAY
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City | ORLANDO
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State | FL
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Zip | 32836-5524
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Country | US
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Telephone | 917-226-0284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 51337
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 190318
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RT0003X
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Taxonomy Name | Transplant Hepatology Physician
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License Number | ME135670
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME135670
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number | ME135670
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number | 190318
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License Number State | NY
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