Provider Demographics
NPI:1902877400
Name:BASTA, SAMEH A (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:A
Last Name:BASTA
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:ONE COLUMBUS CENTER, SUITE 600
Mailing Address - Street 2:283 CONSTITUTION DRIVE
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-687-8190
Mailing Address - Fax:
Practice Address - Street 1:ONE COLUMBUS CENTER, SUITE 600
Practice Address - Street 2:283 CONSTITUTION DRIVE
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-687-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006089836Medicaid
VA250839OtherANTHEM
VA12881OtherSENTARA OHP/SHP
NC0637KOtherNC BC BS
VAPAROtherMID ATLANTIC/VICARE
VAPAROtherCHAMPUS/TRICARE
VAPAROtherAETNA
VAPAROtherFIRSTHEALTH
VAPAROtherCORVEL/CORCARE
VA238389OtherUNITED HEALTHCARE/MAMSI
NC890637KMedicaid
VAPAROtherUSA MANAGEDCARE
VAPAROtherVA HEALTHNET/PHCS
VAPAROtherMULTIPLAN/AMERICAS HEALTH
VAPAROtherVA PREMIER
VAPAROtherCIGNA
VA238389OtherUNITED HEALTHCARE/MAMSI
NC0637KOtherNC BC BS
VAPAROtherMULTIPLAN/AMERICAS HEALTH