Individual
PHANEL BASILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 COMBS RD, PENNINGTON GAP, VA 24277-1808
(276) 546-1440
(865) 291-3228
Mailing address
PO BOX 636019, CINCINNATI, OH 45263-6019
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101035989
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0125442
BC BS
TN
05
—
1750310561
—
VA
05
—
3050025
—
TN
05
—
64796055
—
KY
01
—
P00209168
RAILROAD MEDICARE
VA
Enumeration date
07/02/2006
Last updated
11/06/2007
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