# HAVEN MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710369368
- **Authorized official:** DR. SANJAY BASU MD (CEO)
- **Authorized official phone:** (617) 646-9912

## Contact information

- **Practice address:** 86 BAKER AVENUE EXT, CONCORD, MA 01742-2132
- **Practice address phone:** (978) 391-9275
- **Mailing address:** 86 BAKER AVENUE EXT, CONCORD, MA 01742-2132
- **Mailing address phone:** (978) 391-9275

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/19/2015
- **Last updated:** 01/10/2018