Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD036543E | PA |
NPI | 1275076051 |
---|---|
Provider Name | Alan Baseman |
First Address | Chalfont, PA 18914 |
Second Address | Chalfont, PA 18914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 28/11/2016 |