Healthcare Provider Details

I. General information

NPI: 1164858858
Provider Name (Legal Business Name): CAROLINE BASHORE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BOULEVARD PROFESSIONAL OFFICE BLDG 1, STE. 305
UPLAND PA
19013
US

IV. Provider business mailing address

30 MEDICAL CENTER BOULEVARD PROFESSIONAL OFFICE BLDG 1, STE. 305
UPLAND PA
19013
US

V. Phone/Fax

Practice location:
  • Phone: 610-874-6448
  • Fax:
Mailing address:
  • Phone: 610-874-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS018759
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: