Provider Demographics
NPI:1023096377
Name:BASSO, ANA CRISTINA (MD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:CRISTINA
Last Name:BASSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGSLEY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4604
Mailing Address - Country:US
Mailing Address - Phone:757-451-0929
Mailing Address - Fax:757-423-4901
Practice Address - Street 1:301-6 GREAT TEAYS BLVD
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560
Practice Address - Country:US
Practice Address - Phone:304-757-6999
Practice Address - Fax:304-757-3252
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252920207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001788656OtherBLUE CROSS BLUE SHIELD
WV3810002690Medicaid
7913705OtherAETNA
WV3810002690Medicaid
2031026Medicare PIN
2031027Medicare PIN
2031024Medicare PIN
2031021Medicare PIN
001788656OtherBLUE CROSS BLUE SHIELD
7913705OtherAETNA
I33575Medicare UPIN
2031025Medicare PIN