MEDICARE: ANJUM MOHAMMAD FNP-BC

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	363LF0000X	Family Nurse Practitioner	26NJ00621600	NJ
2	363LF0000X	Family Nurse Practitioner	SP015929	PA

General Provider Information

NPI Number	:	1336699206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJUM MOHAMMAD FNP-BC

Provider Business Mailing Address
First Line	:	3992 POWELL RD
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-3854
Country	:	US
Telephone Number	:	732-222-8098
Fax Number	:

Provider Business Practice Location Address
First Line	:	3992 POWELL RD
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-3854
Country	:	US
Telephone Number	:	732-222-8098
Fax Number	:

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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