Provider Demographics
NPI:1538157219
Name:BASKIN, LAURA REBECCA (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:REBECCA
Last Name:BASKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2598
Mailing Address - Country:US
Mailing Address - Phone:615-867-8040
Mailing Address - Fax:615-893-1769
Practice Address - Street 1:4323 CAROTHERS PKWY STE 505
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5920
Practice Address - Country:US
Practice Address - Phone:615-721-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36292208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3873494Medicaid
TN3873494Medicaid
TN3873494Medicare ID - Type Unspecified