=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386171668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLI BASCOM DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2017
-----------------------------------------------------
Last Update Date | 03/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1865 ROUTE 70 EAST STE 210
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08003-2013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-795-0587
-----------------------------------------------------
Fax | 856-795-0689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1865 MARLTON PIKE EAST ROUTE 70
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08003-8003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-795-0587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 25MB11065700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------