Individual
DR. RENEE E BASKERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
90 WASHINGTON ST, SUITE 209, EAST ORANGE, NJ 07017
(973) 677-1551
(973) 509-2658
Mailing address
PO BOX 141, MONTCLAIR, NJ 07042
(973) 677-1551
(973) 509-2658
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MA50489
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2016907
—
NJ
Enumeration date
04/18/2007
Last updated
07/08/2007
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