MEDICARE: DR. FREDERICK CALVIN BASILICO 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	207RI0011X	Interventional Cardiology Physician	41593	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2500051	OTHER	UNITED HEALTH CARE
3	3039	OTHER	HARVARD PILGRIM HEALTHCAR

General Provider Information

NPI Number	:	1316946882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK CALVIN BASILICO M.D.

Provider Business Mailing Address
First Line	:	125 PARKER HILL AVE
Second Line	:	STE 450
City	:	ROXBURY CROSSING
State	:	MA
Zip	:	02120-2847
Country	:	US
Telephone Number	:	617-754-5910
Fax Number	:	617-754-5950

Provider Business Practice Location Address
First Line	:	125 PARKER HILL AVE
Second Line	:	STE 450
City	:	ROXBURY CROSSING
State	:	MA
Zip	:	02120-2847
Country	:	US
Telephone Number	:	617-754-5910
Fax Number	:	617-754-5950

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/15/2009

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