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General NPI Number Information
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NPI Number | 1437312758
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Entity Type | Individual
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Provider Name | BASHAR ERICSOOSSI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 250 E DAY RD STE 300
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City | MISHAWAKA
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State | IN
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Zip | 46545-3471
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Country | US
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Telephone | 574-968-0283
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Fax | 574-968-0882
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Provider Business Mailing Address
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Address Line | 40 VALLEY STREAM PKWY STE 100
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City | MALVERN
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State | PA
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Zip | 19355-1407
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Country | US
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Telephone | 610-644-8900
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Fax | 484-924-0053
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 274622
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 01089928A
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License Number State | IN
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