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General NPI Number Information
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NPI Number | 1649512054
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Entity Type | Individual
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Provider Name | ANJAN MANDYAM BASOOR MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2013
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 1001 SAM PERRY BLVD
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4453
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Country | US
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Telephone | 407-415-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W PUEBLO ST
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City | SANTA BARBARA
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State | CA
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Zip | 93105-4353
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Country | US
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Telephone | 805-569-7573
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101287045
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME161368
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A134629
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 319700
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License Number State | NY
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