MEDICARE: MADINA BAKHITOVA PSYD

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	103T00000X	Psychologist	PS020347	PA

General Provider Information

NPI Number	:	1184045312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADINA BAKHITOVA PSYD

Provider Business Mailing Address
First Line	:	2010 W CHESTER PIKE STE 314
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2737
Country	:	US
Telephone Number	:	610-892-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 W CHESTER PIKE STE 314
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2737
Country	:	US
Telephone Number	:	610-892-3800
Fax Number	:

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

Provider Enumeration Date	:	12/13/2013
Last Update Date	:	12/23/2024

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