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General NPI Number Information
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NPI Number | 1073795639
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Entity Type | Organization
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Legal Business Name | SHANTANU BASU MD PC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 125 PARKER HILL AVE SUITE 385
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City | ROXBURY CROSSING
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State | MA
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Zip | 02120-2847
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Country | US
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Telephone | 617-277-5587
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Fax | 617-232-1660
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Provider Business Mailing Address
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Address Line | 125 PARKER HILL AVE SUITE 385
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City | ROXBURY CROSSING
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State | MA
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Zip | 02120-2847
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Country | US
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Telephone | 617-277-5587
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Fax | 617-232-1660
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Authorized Official
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Title or Position | GENERAL SURGERY
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Name | DR. SHANTANU G BASU
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Credential |
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Telephone | 617-277-5587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 44318
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License Number State | MA
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