Provider Demographics
NPI:1902313331
Name:BASHAW, EZRA
Entity Type:Individual
Prefix:
First Name:EZRA
Middle Name:
Last Name:BASHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-777-1000
Mailing Address - Fax:603-777-1001
Practice Address - Street 1:7 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2118
Practice Address - Country:US
Practice Address - Phone:603-777-1000
Practice Address - Fax:603-777-1001
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1773363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical