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General NPI Number Information
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NPI Number | 1619073319
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Entity Type | Individual
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Provider Name | CHERYL LUCY BASCOM M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 613 23RD ST STE 430
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City | ASHLAND
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State | KY
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Zip | 41101-2885
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Country | US
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Telephone | 606-408-8200
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Fax | 606-408-6291
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Provider Business Mailing Address
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Address Line | PO BOX 2379
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City | ASHLAND
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State | KY
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Zip | 41105-2379
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Country | US
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Telephone | 606-408-6200
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Fax | 606-408-6612
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 38583
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License Number State | KY
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