Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 269908 | MA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 269908 | MA |
NPI | 1366978108 |
---|---|
Provider Name | Dr. Georges Basile |
First Address | Boston, MA 02115 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 06/09/2017 |