Basic Information
| Provider Information | |||||||||
| NPI: | 1467565796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASU | ||||||||
| FirstName: | DILIP | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2335 CHESTERFIELD AVENUE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043462284 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2335 CHESTERFIELD AVE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043462284 | ||||||||
| FaxNumber: | 3043467470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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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 | 207RI0011X | 09941 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 09941 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 09941 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01064340 | 01 | WV | MEDICARE RAILROAD | OTHER |