Provider Demographics
NPI:1710558655
Name:HUMOS, BASEL (MD)
Entity type:Individual
Prefix:
First Name:BASEL
Middle Name:
Last Name:HUMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BURLINGTON MALL ROAD DEPARTMENT OF CARDIOLOGY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:857-264-7848
Mailing Address - Fax:
Practice Address - Street 1:41 BURLINGTON MALL ROAD DEPARTMENT OF CARDIOLOGY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:857-264-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2024-07-02
Deactivation Date:2022-12-13
Deactivation Code:
Reactivation Date:2023-01-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program