Basic Information
Provider Information | |||||||||
NPI: | 1023122769 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BASILI | ||||||||
FirstName: | ANNAMARIA | ||||||||
MiddleName: | GERMAINE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ZONAK | ||||||||
OtherFirstName: | ANNAMARIA | ||||||||
OtherMiddleName: | GERMAINE BASILI | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PH.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 400 GRIST MILL XING | ||||||||
Address2: |   | ||||||||
City: | SEVERNA PARK | ||||||||
State: | MD | ||||||||
PostalCode: | 211462321 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4109878353 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 10 N GREENE ST | ||||||||
Address2: |   | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212011524 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4106057000 | ||||||||
FaxNumber: | 4106057702 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/19/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 00004 | MD | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.