Provider Demographics
NPI:1730343120
Name:BASI, PUNEET
Entity type:Individual
Prefix:
First Name:PUNEET
Middle Name:
Last Name:BASI
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 1:165 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4500
Mailing Address - Country:US
Mailing Address - Phone:804-330-4901
Mailing Address - Fax:
Practice Address - Street 1:1600 WILKES RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7964
Practice Address - Country:US
Practice Address - Phone:804-330-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101282023207RG0100X
PAMD434753207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology