MEDICARE: DR. RANDA BAHER FODA 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	207Q00000X	Family Medicine Physician	25MA07595300	NJ

General Provider Information

NPI Number	:	1881629178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDA BAHER FODA M.D.

Provider Business Mailing Address
First Line	:	2000 ACADEMY DR STE 600
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2833
Country	:	US
Telephone Number	:	856-914-9656
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 ACADEMY DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2831
Country	:	US
Telephone Number	:	856-985-9100
Fax Number	:	856-985-9106

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/25/2024

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