MEDICARE: DR. HABIB FOUAD BASSIL 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	207RC0000X	Cardiovascular Disease Physician	0101044555	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	:	1710944707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HABIB FOUAD BASSIL MD

Provider Business Mailing Address
First Line	:	4402 BRENTWOOD DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-2955
Country	:	US
Telephone Number	:	434-572-1381
Fax Number	:	434-572-1381

Provider Business Practice Location Address
First Line	:	2232 WILBORN AVE
Second Line	:	SUITE A
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-1662
Country	:	US
Telephone Number	:	434-572-8977
Fax Number	:	434-572-2510

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	09/15/2016

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