Garrick Mansa Baskerville, MD
Individual provider Active NPI Family Medicine Physician · Milmont Park, PA
NPI 1154539708 · NPPES record last updated Jun 19, 2014
Key facts
- NPI
- 1154539708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD439952 (PA)
- Practice address
- 500 Macdade Blvd
Milmont Park, PA 19033-3311 - Phone
- (610) 619-7300
- Fax
- (610) 522-0445
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7-0003720 | DE | MD | Family Medicine Physician |
| MD439952 | PA | MD | Family Medicine Physician |
Interoperability endpoints
- garrick.baskerville@177410112421892.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C7-0003720 | DE | |
| Family Medicine Physician | 207Q00000X | MD439952 | PA | Yes |
Addresses
Primary practice location
500 Macdade Blvd
Milmont Park, PA 19033-3311
Mailing address
500 Macdade Blvd
Milmont Park, PA 19033-3311
Phone (610) 619-7300
Other providers in Milmont Park, PA
- Christine Frances Ambrose
- Paula Estelle Dimaio
- Divinely Assigned Homecare Solutions LLC
- For Eyes Optical of PA
- Health Access Network
- Kimberly Ann Lucik
All providers in Milmont Park, PA · Family Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.