Provider Demographics
NPI:1770563249
Name:BASTIKS, DAGMARA ELGA (MD)
Entity type:Individual
Prefix:DR
First Name:DAGMARA
Middle Name:ELGA
Last Name:BASTIKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:204 WALDEN CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-8993
Mailing Address - Country:US
Mailing Address - Phone:252-672-5665
Mailing Address - Fax:
Practice Address - Street 1:PSC BOX 8023 BEAUFORT ROAD
Practice Address - Street 2:HALYBURTON NAVAL HOSPITAL, BLGD 4389
Practice Address - City:CHERRY POINT NAVAL AIR STATION
Practice Address - State:NC
Practice Address - Zip Code:28533-0023
Practice Address - Country:US
Practice Address - Phone:252-466-0144
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134125-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery