MEDICARE: MURALIDHARAN R BASKER 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	208600000X	Surgery Physician	0101242053	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891088449	OTHER	VA	GROUP NPI

General Provider Information

NPI Number	:	1972543650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MURALIDHARAN R BASKER MD

Provider Business Mailing Address
First Line	:	11525 SINKER CREEK DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-5427
Country	:	US
Telephone Number	:	804-731-9367
Fax Number	:

Provider Business Practice Location Address
First Line	:	16021 KAIROS ROAD
Second Line	:	SUITE A
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-5205
Country	:	US
Telephone Number	:	804-415-8966
Fax Number	:	804-451-1852

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/06/2015

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