MEDICARE: DR. JOHN M. BASHANT 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	207R00000X	Internal Medicine Physician	224134	NY

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	:	1912908195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M. BASHANT D.O.

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 PALISADES DRIVE SUITE 200
Second Line	:	ST. PETER'S INTERNAL MEDICINE
City	:	ALBANY
State	:	NY
Zip	:	12205-6433
Country	:	US
Telephone Number	:	518-438-0019
Fax Number	:	518-438-0299

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/06/2021

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