Individual
MATTHEW CLARK BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
833 CHESTNUT ST # 1035, PHILADELPHIA, PA 19107-4414
(888) 816-3862
Mailing address
2000 VIVIGEN WAY, SANTA FE, NM 87505
(800) 326-7002
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
2002022
AZ
Other
Enumeration date
03/02/2007
Last updated
07/08/2007
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