MEDICARE: DR. BAHER A BASTA MD

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	207R00000X	Internal Medicine Physician	0101237664	VA
2	207RN0300X	Nephrology Physician	0101237664	VA

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	:	1538130257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAHER A BASTA MD

Provider Business Mailing Address
First Line	:	5234 DEFORD RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-7208
Country	:	US
Telephone Number	:	757-499-6978
Fax Number	:	858-925-1353

Provider Business Practice Location Address
First Line	:	3800 POPLAR HILL RD STE A
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5522
Country	:	US
Telephone Number	:	757-499-6978
Fax Number	:	858-925-1353

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	11/01/2021

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