MEDICARE: MAHIMA TIBREWAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD443098	PA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2080N0001X	Neonatal-Perinatal Medicine Physician	MD443098	PA

General Provider Information

NPI Number	:	1134385644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHIMA TIBREWAL MD

Provider Business Mailing Address
First Line	:	1000 HADDONFIELD BERLIN RD STE 210
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-3520
Country	:	US
Telephone Number	:	856-782-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	1872 ST LUKES BLVD
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5669
Country	:	US
Telephone Number	:	484-526-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	02/03/2022

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