MEDICARE: DR. MOMINA I MASTOOR M.D.

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	207RC0000X	Cardiovascular Disease Physician	D0050822	MD
2	207RC0000X	Cardiovascular Disease Physician	MD468797	PA

General Provider Information

NPI Number	:	1336119742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOMINA I MASTOOR M.D.

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-399-3105
Fax Number	:	717-798-3670

Provider Business Practice Location Address
First Line	:	450 S WASHINGTON ST STE A
Second Line	:
City	:	GETTYSBURG
State	:	PA
Zip	:	17325-2500
Country	:	US
Telephone Number	:	717-339-3105
Fax Number	:	717-798-3670

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/29/2024

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