Individual
DR. BASHAR ERICSOOSSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 E DAY RD STE 300, MISHAWAKA, IN 46545-3471
(574) 968-0283
(574) 968-0882
Mailing address
40 VALLEY STREAM PKWY STE 100, MALVERN, PA 19355-1407
(610) 644-8900
(484) 924-0053
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01089928A
IN
207RN0300X
Nephrology Physician
274622
NY
Other
Enumeration date
07/07/2008
Last updated
08/13/2025
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