Provider Demographics
NPI:1174083794
Name:BASILIOS, PETER (PA-C)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BASILIOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 PLEASANT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3005
Mailing Address - Country:US
Mailing Address - Phone:508-672-0545
Mailing Address - Fax:508-672-0547
Practice Address - Street 1:120 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4336
Practice Address - Country:US
Practice Address - Phone:401-738-3730
Practice Address - Fax:401-738-3777
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA01112363AS0400X, 363AM0700X
MAPA8369363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical