Provider Demographics
NPI:1881325538
Name:BASU, PRABHAT KUMAR (MD)
Entity type:Individual
Prefix:
First Name:PRABHAT
Middle Name:KUMAR
Last Name:BASU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5134
Mailing Address - Country:US
Mailing Address - Phone:916-746-3590
Mailing Address - Fax:
Practice Address - Street 1:ALBERT EINSTEIN MEDICAL CENTER
Practice Address - Street 2:5501 OLD YORK ROAD
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:484-622-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT227142207Q00000X
CAA200606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine