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General NPI Number Information
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NPI Number | 1437247756
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Entity Type | Individual
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Provider Name | MAURICIO DIONISIO BAS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1970 OPITZ BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3304
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Country | US
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Telephone | 703-494-8174
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Fax | 703-730-2155
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Provider Business Mailing Address
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Address Line | PO BOX 4806
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City | WOODBRIDGE
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State | VA
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Zip | 22194-4806
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Country | US
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Telephone | 703-494-8174
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Fax | 703-730-2155
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0101022428
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License Number State | VA
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