MEDICARE: MS. THERESA MARY BASESKI D.O.

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	207V00000X	Obstetrics & Gynecology Physician	OS007866L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245260850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA MARY BASESKI D.O.

Provider Business Mailing Address
First Line	:	2100 MACK BLVD FL 4
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-5622
Country	:	US
Telephone Number	:	705-790-2391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 ALLIANCE DR STE 10
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18202-3234
Country	:	US
Telephone Number	:	570-501-6450
Fax Number	:	570-501-6436

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	01/08/2024

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