MEDICARE: DENISE STELLA BARBA BASILAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD189073	OR

General Provider Information

NPI Number	:	1144323346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE STELLA BARBA BASILAN M.D.

Provider Business Mailing Address
First Line	:	370 LINCOLN ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4350
Country	:	US
Telephone Number	:	971-599-1002
Fax Number	:	503-967-6107

Provider Business Practice Location Address
First Line	:	370 LINCOLN ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4350
Country	:	US
Telephone Number	:	971-599-1002
Fax Number	:	503-967-6107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/06/2025

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