Individual
DR. KEVIN LEO BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 CHARLES LINDBERGH BLVD STE B, UNIONDALE, NY 11553-3658
(516) 794-4646
(516) 794-2014
Mailing address
99 PLYMOUTH DR N, GLEN HEAD, NY 11545-1126
(516) 759-6575
(516) 794-2014
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
201500
NY
Other
Enumeration date
05/07/2007
Last updated
07/08/2007
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