Basel Otoom

Primary specialty

DentistTaxonomy code 122300000X

License

DL15170 Issued in MA

Practice address

20 Indian Hill Road
West Tisbury, MA 02575

Phone

(508) 338-7170

NPI assigned

Apr 27, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1437893245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 HOSPITAL AVE",
            "city": "NORTH ADAMS",
            "state": "MA",
            "postal_code": "012472550",
            "telephone_number": "617-697-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 INDIAN HILL ROAD",
            "city": "WEST TISBURY",
            "state": "MA",
            "postal_code": "02575",
            "telephone_number": "508-338-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTOOM",
        "first_name": "BASEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DL15170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Server",
            "affiliation": "N",
            "address_1": "20 Indian hill road",
            "city": "West Tisbury",
            "state": "MA",
            "country_code": "US",
            "postal_code": "02575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Marthas Vineyard Ear Nose and Throat Specialists PC
• Bryan P McShea, D.C.
• Karen F Meeks, LICSW
• Helen Neumann, LIC ACC
• Jessica E Oconnor, P.T.
• Rufus W. Peebles, ED. D., J. D.
• Lesley Segal, AUD
• Jerome Dennis Segel, DPM
• Sander S Shapiro, M.D.
• Deborah Ann Shipkin, OT

• Dentist in West Tisbury, MA
• Providers in West Tisbury, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.