KEVIN BASHAM (Credential# 1231648) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is August 1, 2017. The license expiration date date is July 31, 2018. The license status is INACTIVE.
KEVIN BASHAM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.053398. The credential type is physician/surgeon. The effective date is August 1, 2017. The expiration date is July 31, 2018. The business address is 99 Plymouth Dr. North, Glen Head, NY 11545. The current status is inactive.
| Licensee Name | KEVIN BASHAM |
| Credential ID | 1231648 |
| Credential Number | 1.053398 |
| Credential Type | Physician/Surgeon |
| Business Address |
99 Plymouth Dr. North Glen Head NY 11545 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2014-08-01 |
| Effective Date | 2017-08-01 |
| Expiration Date | 2018-07-31 |
| Refresh Date | 2018-11-03 |
| Street Address | 99 Plymouth Dr. North |
| City | Glen Head |
| State | NY |
| Zip Code | 11545 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Panagiotis Koklanos | 96 Plymouth Dr N, Glen Head, NY 11545 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Allison R Aikman | 21 Beechwood Drive, Glen Head, NY 11545 | Notary Public Appointment | 2016-07-22 ~ 2021-07-31 |
| Jane S Fagan | 136 High Farms Road, Glen Head, NY 11545 | Notary Public Appointment | 2005-12-05 ~ 2010-12-31 |
| Banfi Products Corp | 1111 Cedar Swamp Rd, Old Brookville, NY 11545 | Out of State Shipper Liquor | 2019-10-11 ~ 2020-10-10 |
| Suraj Rambhia | 3 Bridle Path Court, Glen Head, NY 11545 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
| Richard B Serchuk | 5 Valentines Lane, Old Brookville, NY 11545 | Dentist | 2019-06-01 ~ 2020-05-31 |
| John A Notaro | 1005 Glen Cove Ave, Glen Head, NY 11545 | Architect | 2016-08-01 ~ 2017-07-31 |
| Song Young Yu | 14a Quaker Ridge Dr., Brookville, NY 11545 | Physician/surgeon | 2016-01-01 ~ 2016-12-31 |
| Michael Haratunian | 1 Salem Way, Glen Head, NY 11545 | Professional Engineer | 2005-02-01 ~ 2006-01-31 |
| Laura A Lamantia | 21 Elin Pl, Glenhead, NY 11545 | Real Estate Salesperson | ~ |
| Find all Licenses in zip 11545 | |||
| City | Glen Head |
| Zip Code | 11545 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Glen Head |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kevin W Dickey Md | Po Box 217, New Britain, CT 06050-0217 | Physician/surgeon | 2014-09-01 ~ 2015-08-31 |
| Kevin Y Pei | Po Box 208062, New Haven, CT 06520 | Physician/surgeon | 2018-06-01 ~ 2019-05-31 |
| Kevin J Tally | 16 Rip Rd, Hanover, NH 03755-1614 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Kevin L Soe | 26 Jasmine Dr, Middletown, NY 10940-5046 | Physician/surgeon | 2015-08-01 ~ 2016-07-31 |
| Kevin D Mcmahon | 546 So Broad St, Meriden, CT 06450 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Kevin Vincent Kelly | 11 E 87th St Ste 1b, New York, NY 10128-0528 | Physician/surgeon | ~ |
| Kevin Strong Md | 111 Beach Rd, Fairfield, CT 06824 | Physician/surgeon | 2008-08-20 ~ 2009-09-30 |
| Kevin S. Grewal Md | 120 Leeuwarden Rd, Darien, CT 06820-3027 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Kevin D Wolter | Pfizer, Groton, CT 06340 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Kevin D Miller Md | 195 Hillspoint Rd, Westport, CT 06880 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
Please comment or provide details below to improve the information on KEVIN BASHAM.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).