Provider Demographics
NPI:1902839780
Name:BASRAWALA, ZANE (MD)
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:
Last Name:BASRAWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36488
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6488
Mailing Address - Country:US
Mailing Address - Phone:704-248-3400
Mailing Address - Fax:
Practice Address - Street 1:10650 PARK RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8538
Practice Address - Country:US
Practice Address - Phone:704-541-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601044208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80300008Medicaid
P00391240OtherRAILROAD MEDICARE
NC1431GOtherBCBS NORTH CAROLINA
NC1431GOtherBCBS NORTH CAROLINA
P00391240OtherRAILROAD MEDICARE