Basic Information
| Provider Information | |||||||||
| NPI: | 1225125834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASSETT | ||||||||
| FirstName: | CORTLAND | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 CLOVER LN | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148504930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072773679 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 WAYMAN LN | ||||||||
| Address2: | MOUNT DESERT ISLAND HOSPITAL | ||||||||
| City: | BAR HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046091625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072885081 | ||||||||
| FaxNumber: | 2072887024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA697 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363L00000X | 000792 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207P00000X | 000792 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | PA697 | 01 | ME | LICENSE | OTHER |