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General NPI Number Information
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NPI Number | 1487643656
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Entity Type | Individual
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Provider Name | RICHARD M BASILE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 369 SOUTH ST SUITE 1
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City | PITTSFIELD
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State | MA
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Zip | 01201-6803
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Country | US
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Telephone | 413-281-3752
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Fax |
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Provider Business Mailing Address
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Address Line | 369 SOUTH ST PO BOX 1366
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City | PITTSFIELD
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State | MA
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Zip | 01201-6803
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Country | US
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Telephone | 413-281-3752
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 43007
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License Number State | MA
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