Healthcare Provider Details

I. General information

NPI: 1912303033
Provider Name (Legal Business Name): MASUMA BAHORA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MALL BLVD STE 220
KING OF PRUSSIA PA
19406
US

IV. Provider business mailing address

609 W GERMANTOWN PIKE STE 202
EAST NORRITON PA
19403-4243
US

V. Phone/Fax

Practice location:
  • Phone: 484-622-7940
  • Fax:
Mailing address:
  • Phone: 484-622-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09582000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD457598
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09582000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: