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General NPI Number Information
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NPI Number | 1215756705
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Entity Type | Organization
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Legal Business Name | SUPARNA BASU MD PC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 40886 GOODWIN WAY
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City | MADERA
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State | CA
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Zip | 93636-9900
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Country | US
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Telephone | 516-232-5732
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Fax |
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Provider Business Mailing Address
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Address Line | 2609 SUNNY MDWS
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City | MCKINNEY
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State | TX
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Zip | 75072-4054
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Country | US
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Telephone | 516-232-5732
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Fax |
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Authorized Official
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Title or Position | MD
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Name | SUPARNA BASU
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Credential |
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Telephone | 516-232-5732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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