Healthcare Provider Details

I. General information

NPI: 1386171668
Provider Name (Legal Business Name): MOLLI BASCOM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 ROUTE 70 EAST STE 210
CHERRY HILL NJ
08003-2013
US

IV. Provider business mailing address

1865 MARLTON PIKE EAST ROUTE 70
CHERRY HILL NJ
08003-8003
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-0587
  • Fax: 856-795-0689
Mailing address:
  • Phone: 856-795-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB11065700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: