MEDICARE: ROBERTA BASHORE

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	207Q00000X	Family Medicine Physician	MD066214L	PA

General Provider Information

NPI Number	:	1285626820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA BASHORE

Provider Business Mailing Address
First Line	:	1800 PINE HOLLOW RD
Second Line	:	SUITE 4B
City	:	MC KEES ROCKS
State	:	PA
Zip	:	15136-1516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 PINE HOLLOW RD
Second Line	:	SUITE 4B
City	:	MC KEES ROCKS
State	:	PA
Zip	:	15136-1516
Country	:	US
Telephone Number	:	412-331-6503
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/25/2021

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